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Short-term clinical and radiographic outcomes of chemonucleolysis with condoliase for painful lumbar disc herniation and analysis regarding intradiscal injection area

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Abstract

Percutaneous chemonucleolysis with condoliase has been available for painful lumbar disc herniation since 2018 in Japan. This study investigated clinical and radiographic outcomes three months after the administration because the secondary surgical removal is most required during this period for the insufficient pain relief, and analyzed whether the differences of intradiscal injection areas affected the clinical outcomes. We retrospectively investigated 47 consecutive patients (males, 31; median age, 40 years) three months after the administration. Clinical outcomes were evaluated using the Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ), a visual analog scale (VAS) score for low back pain, and VAS scores for pains and numbness in the lower limbs. Radiographic outcomes were analyzed in 41 patients, using parameters such as mid-sagittal disc height and maximal protrusion length of herniation on MRI preoperatively and at the final follow-up. Postoperative median evaluation period was 90 days. The effective rate of low back pain based on the pain-related disorders at baseline and the last follow-up in the JOABPEQ reached 79.5%. The postoperative proportion of VAS scores recovery ≥ 2 points and ≥ 50% for pains in the lower limbs were 80.9% and 66.0%, respectively, revealing satisfactory effectiveness. Preoperative median mid-sagittal disc height significantly reduced from 9.5 to 7.6 mm postoperatively. There were no significant differences in pain relief in the lower limbs by injection areas in the center and the dorsal 1/3rd near the herniation of nucleus pulposus. Chemonucleolysis with condoliase revealed satisfactory short-term outcomes after the administration regardless of intradiscal injection areas.

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Acknowledgements

We are grateful to the radiologists of my hospital for their prompt preoperative radiological examinations and image processing work. The authors would like to thank FORTE for the English language review.

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Authors and Affiliations

  1. Department of Spinal Surgery, Brain Attack Center, Ota Memorial Hospital, 3-6-28 Okinogami, Fukuyama, Hiroshima, 720-0825, Japan

    Tatsuya Ohtonari & Nobuharu Nishihara

  2. Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan

    Rina Torii, Shohei Noguchi & Takehiro Kitagawa

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  1. Tatsuya Ohtonari
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  2. Rina Torii
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  3. Shohei Noguchi
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  4. Takehiro Kitagawa
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  5. Nobuharu Nishihara
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Contributions

The study conception and design were proposed by Tatsuya Ohtonari. Data collection was performed by Tatsuya Ohtonari, Rina Torii, Shohei Noguchi, Takehiro Kitagawa and Nobuharu Nishihara. Formal analysis was performed by Tatsuya Ohtonari, Rina Torii and Shohei Noguchi. The first draft of the manuscript was written by Tatsuya Ohtonari and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Tatsuya Ohtonari.

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Ethical approval and Consent to participate

This retrospective study was approved by the institutional review board at the Brain Attack Center, Ota Memorial Hospital (registration No: 230). Since this was a retrospective study, the requirement for written informed consent from patients was waived.

Human and animal ethics

This retrospective study was performed in accordance with the Declaration of Helsinki.

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This manuscript contains no individual person’s data in any form.

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The authors have no relevant financial or non-financial interests to disclose.

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Portions of this work were presented in the symposium at the 81st Annual Meeting of the Japan Neurosurgical Society, September 30, 2022, Yokohama, Japan.

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Ohtonari, T., Torii, R., Noguchi, S. et al. Short-term clinical and radiographic outcomes of chemonucleolysis with condoliase for painful lumbar disc herniation and analysis regarding intradiscal injection area. Neurosurg Rev 46, 59 (2023). https://doi.org/10.1007/s10143-023-01966-w

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