Purpose: Despite the presence of numerous consistent reports regarding the efficacy of intravertebral disc enzyme injection (condoliase) for lumbar disc herniation, there remains a lack of consensus concerning the timing of its effectiveness onset. In this study, we present the findings from a cohort of 100 consecutive patients who received condoliase treatment since its initial introduction at our hospital.
The study encompassed 102 consecutive patients who underwent condoliase treatment at our hospital between December 2018 and July 2023. The average observation period was 6.1 months, with an average patient age of 43.7 years, comprising 67 men and 35 women. Our evaluation encompassed the affected disc level, VAS (Visual Analog Scale) values for leg pain both before and after condoliase treatment, the number of patients experiencing symptomatic improvement (defined as a VAS value below 50% before treatment), disc degeneration (assessed through Pfirrmann classification and Modic degeneration) as observed on MRI, the incidence of adverse events, and the number of patients who subsequently underwent surgery.
The affected disc levels were distributed as follows: L1/2 in 3 cases, L2/3 in 5 cases, L3/4 in 11 cases, L4/5 in 70 cases, and L5/S1 in 13 cases. The median duration of the disease was 20 weeks. The mean leg pain VAS measured 7.4±2.1 before treatment, which subsequently decreased to 3.7±2.4 and 2.4±2.2 after 1 month and 3 months, respectively, indicating a significant improvement over time (P<0.05). Symptomatic improvement was noted in 87 patients (85.3%), with a median time of symptom relief being 4 weeks. In contrast, symptoms remained unchanged or worsened in 10 patients (9.8%), leading to surgical intervention in 5 of them (2.1%). No cases of paralysis were recorded, but there were 2 cases (2%) reporting allergic symptoms and 5 cases (2.1%) of patient dropout.
MRI scans revealed that patients exhibited Pfirrmann Classification Grade II, III, and IV (27, 68, and 7 cases, respectively) before treatment. Among the 86 patients (84.3%) for whom MRI images were available at the 3-month post-treatment mark, 46 (53.5%) demonstrated Grade I progression, and 5 (5.8%) showed Grade II progression. Modic degeneration was identified in 14 patients (13.7%) prior to treatment, with Type 1, 2, and 3 occurring in 4, 9, and 1 case(s), respectively. Following treatment, there was a change noted in 6 patients (7%), with 4 cases (4.7%) displaying no degeneration from Type 2 to Type 1 and 2 cases (2.3%) transitioning from Type 2 to Type 1.
Discussion: The results obtained from our study involving 100 consecutive patients who received condoliase treatment at our hospital after its introduction were highly promising. Patients experienced a significant reduction in VAS scores within roughly a month of condoliase treatment, and no severe complications were reported. However, it's worth noting that more than half of the patients exhibited signs of disc degeneration progression on MRI following condoliase administration. Therefore, it is crucial to meticulously select and closely monitor patients over an extended period to track the development of disc degeneration and the potential recurrence of herniation.