• Yusuke Oshita, Daisuke Matsuyama, Daisuke Sakai, Jordy Schol, Eiki Shirasawa, Haruka Emori, Kazuyuki Segami, Shu Takahashi, Kazumichi Yagura, Masayuki Miyagi, Wataru Saito, Takayuki Imura, Toshiyuki Nakazawa, Gen Inoue, Akihiko Hiyama, Hiroyuki Katoh, Tsutomu Akazawa, Koji Kanzaki, Masato Sato, Masashi Takaso, and Masahiko Watanabe.
• Department of Orthopaedic Surgery, Showa University Northern Yokohama Hospital, Yokohama 224-8503, Kanagawa, Japan.
• Medicina (Kaunas). 2022 Sep 15; 58 (9).

AbstractBackground and Objectives: Intradiscal injection of Condoliase (chondroitin sulfate ABC endolyase), a glycosaminoglycan-degrading enzyme, is employed as a minimally invasive treatment for lumbar disc herniation (LDH) and represents a promising option between conservative treatment and surgical intervention. Since its 2018 approval in Japan, multiple single-site trails have highlighted its effectiveness, however, the effect of LDH types, and influences of patient age, sex, etc., on treatment success remains unclear. Moreover, data on teenagers and elderly patients has not been reported. In this retrospective multi-center study, we sought to classify prognostic factors for successful condoliase treatment for LDH and assess its effect on patients < 20 and ≥70 years old. Materials and Methods: We reviewed the records of 137 LDH patients treated through condoliase at four Japanese institutions and assessed its effectiveness among different age categories on alleviation of visual analog scale (VAS) of leg pain, low back pain and numbness, as well as ODI and JOA scores. Moreover, we divided them into either a “group-A” category if a ≥50% improvement in baseline leg pain VAS was observed or “group-N” if VAS leg pain improved <50%. Next, we assessed the differences in clinical and demographic distribution between group-A and group-N. Results: Fifty-five patients were classified as group-A (77.5%) and 16 patients were allocated to group-N (22.5%). A significant difference in Pfirrmann classification was found between both cohorts, with grade IV suggested to be most receptive. A posterior disc angle > 5° was also found to approach statical significance. In all age groups, average VAS scores showed improvement. However, 75% of adolescent patients showed deterioration in Pfirrmann classification following treatment. Conclusions: Intradiscal condoliase injection is an effective treatment for LDH, even in patients with large vertebral translation and posterior disc angles, regardless of age. However, since condoliase imposes a risk of progressing disc degeneration, its indication for younger patients remains controversial.

19 keywords...

hide…