PDF(Pubmed)
Abstract：
UNASSIGNED: Chemonucleolysis with condoliase (chondroitin sulfate ABC endolyase) has been used to treat patients with lumbar disc herniation (LDH) in Japan since 2018. In this study, we retrospectively investigated clinical outcomes in patients who received an intradiscal condoliase injection for LDH and sought to identify significant predictors of good outcome.
UNASSIGNED: Indications for treatment were as follows: (1) unilateral leg pain with or without back pain, (2) nerve root compression caused by LDH confirmed on magnetic resonance imaging (MRI), and (3) leg pain resistant to at least 1 month of conservative treatment, including medication, nerve root block, or physical therapy. Patients with motor weakness or a history of severe allergy were excluded, as were those with the foraminal or sequestrated type of LDH. The injection was defined as effective if the numeric rating scale score for leg pain improved by ≥50% at 6 months post-treatment.
UNASSIGNED: A total of 52 patients (mean age, 45.0 years) were enrolled and classified according to whether the injection was effective (E group, n=40, 76.9%) or less effective (L group, n=9, 17.3%). Three patients (5.8%) underwent herniotomy for residual pain within 6 months of the injection. There were no severe adverse events. Reduction of herniation was seen on MRI more often in the E group than in the L group. The effectiveness in patients with transligamentous LDH was similar to that in patients with subligamentous LDH. High-intensity signal change in the area of LDH on pretreatment T2-weighted MRI was a significant predictor of successful leg pain relief.
UNASSIGNED: An intradiscal condoliase injection was a safe and effective treatment for painful radiculopathy caused by LDH. Leg pain was more likely to improve in patients with high-intensity signal change in the area of LDH before treatment.
UNASSIGNED: Indications for treatment were as follows: (1) unilateral leg pain with or without back pain, (2) nerve root compression caused by LDH confirmed on magnetic resonance imaging (MRI), and (3) leg pain resistant to at least 1 month of conservative treatment, including medication, nerve root block, or physical therapy. Patients with motor weakness or a history of severe allergy were excluded, as were those with the foraminal or sequestrated type of LDH. The injection was defined as effective if the numeric rating scale score for leg pain improved by ≥50% at 6 months post-treatment.
UNASSIGNED: A total of 52 patients (mean age, 45.0 years) were enrolled and classified according to whether the injection was effective (E group, n=40, 76.9%) or less effective (L group, n=9, 17.3%). Three patients (5.8%) underwent herniotomy for residual pain within 6 months of the injection. There were no severe adverse events. Reduction of herniation was seen on MRI more often in the E group than in the L group. The effectiveness in patients with transligamentous LDH was similar to that in patients with subligamentous LDH. High-intensity signal change in the area of LDH on pretreatment T2-weighted MRI was a significant predictor of successful leg pain relief.
UNASSIGNED: An intradiscal condoliase injection was a safe and effective treatment for painful radiculopathy caused by LDH. Leg pain was more likely to improve in patients with high-intensity signal change in the area of LDH before treatment.
摘要：
■自2018年以来，在日本，使用软骨素（硫酸软骨素ABC内溶酶）进行化学核溶解术已用于治疗腰椎间盘突出症（LDH）患者。在这项研究中,我们回顾性调查了接受椎间盘内注射乳糖酶治疗LDH的患者的临床结局,并试图确定良好结局的重要预测因素.
■治疗的适应症如下：（1）伴有或不伴有背痛的单侧腿部疼痛，（2）磁共振成像（MRI）证实LDH引起的神经根压迫，（3）对至少1个月的保守治疗有抵抗力的腿部疼痛，包括药物,神经根阻滞,或者物理治疗.排除运动无力或有严重过敏史的患者，有孔或螯合型LDH的患者也是如此。如果治疗后6个月，腿部疼痛的数字评定量表评分改善≥50％，则将注射定义为有效。
■共有52名患者（平均年龄，45.0年），根据注射是否有效进行分类（E组，n=40，76.9％）或更低的有效性（L组，n=9，17.3%）。3例患者（5.8％）在注射后6个月内因残留疼痛而进行了疝切开术。无严重不良事件发生。在MRI上，E组比L组更常见地减少了疝。跨韧带LDH患者的有效性与韧带下LDH患者的有效性相似。预处理T2加权MRI上LDH区域的高强度信号变化是成功缓解腿部疼痛的重要预测指标。
■椎间盘内注射糖酶治疗LDH引起的痛性神经根病是一种安全有效的治疗方法。治疗前LDH区域有高强度信号改变的患者腿部疼痛更有可能改善。
■治疗的适应症如下：（1）伴有或不伴有背痛的单侧腿部疼痛，（2）磁共振成像（MRI）证实LDH引起的神经根压迫，（3）对至少1个月的保守治疗有抵抗力的腿部疼痛，包括药物,神经根阻滞,或者物理治疗.排除运动无力或有严重过敏史的患者，有孔或螯合型LDH的患者也是如此。如果治疗后6个月，腿部疼痛的数字评定量表评分改善≥50％，则将注射定义为有效。
■共有52名患者（平均年龄，45.0年），根据注射是否有效进行分类（E组，n=40，76.9％）或更低的有效性（L组，n=9，17.3%）。3例患者（5.8％）在注射后6个月内因残留疼痛而进行了疝切开术。无严重不良事件发生。在MRI上，E组比L组更常见地减少了疝。跨韧带LDH患者的有效性与韧带下LDH患者的有效性相似。预处理T2加权MRI上LDH区域的高强度信号变化是成功缓解腿部疼痛的重要预测指标。
■椎间盘内注射糖酶治疗LDH引起的痛性神经根病是一种安全有效的治疗方法。治疗前LDH区域有高强度信号改变的患者腿部疼痛更有可能改善。
