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.
摘要：
自2018年以来，在日本，使用硬脂酶的经皮化学溶解术已用于治疗疼痛性腰椎间盘突出症。这项研究调查了给药后三个月的临床和影像学结果，因为在此期间最需要二次手术切除以缓解疼痛。并分析椎间盘内注射面积的差异是否影响临床结局。我们回顾性调查了47例连续患者(男性，31岁；平均年龄，40年)给药后三个月。使用日本骨科协会背痛问卷（JOABPEQ）评估临床结果，下腰痛的视觉模拟量表（VAS）评分，下肢疼痛和麻木的VAS评分。分析了41例患者的影像学结果，术前和最后随访时使用MRI中矢状椎间盘高度和最大突出长度等参数。术后中位评估期为90天。根据基线和JOABPEQ最后一次随访的疼痛相关疾病，下腰痛的有效率达到79.5%。术后下肢疼痛VAS评分恢复≥2分和≥50%的比例分别为80.9%和66.0%,分别,显示出令人满意的效果。术前正中矢状盘高度从9.5mm明显降低至术后7.6mm。通过髓核突出附近的中央和背侧1/3的注射区域，下肢的疼痛缓解没有显着差异。无论椎间盘内注射区域如何，均在给药后使用旋糖酶进行化学核溶解均显示出令人满意的短期结果。
