Background

Lumbar disc herniation (LDH) is a common cause of low back pain and is associated with degeneration of the nucleus pulposus causing nerve root compression. Chemonucleolysis of the nucleus pulposus with condoliase is a low-invasive treatment for LDH. The purpose of this study was to investigate changes in Pfirrmann criteria, which are used to evaluate disc degeneration, after injection of condoliase into a herniated intervertebral disc, and to identify factors associated with disc degeneration at 3 months post-injection.

Methods

Medical records and radiographic findings were reviewed retrospectively for 127 patients with LDH (88 male, 39 female, mean age: 46.6 ± 17.1 years, mean follow-up: 9.8 ± 7.8 months) who underwent chemonucleolysis with intradiscal condoliase injection at our center since September 2018. Condoliase (1.25 U/mL; 1 mL volume) was injected toward the middle of the affected intervertebral nucleus pulposus using a 21-gauge disc-puncture needle.

Results

Cases in which the Pfirrmann grade did and did not progress in the 3 months after the injection were included in groups P (progression, n = 49) and NP (non-progression, n = 78), respectively. Logistic regression analysis of progression of Pfirrmann grade post-injection showed significant associations with age <40 years (p = 0.013, odds ratio (OR): 3.69, 95% confidence interval (CI): 1.32–10.31), Pfirrmann Grade II or III at baseline (p = 0.021, OR: 3.51, 95% CI: 1.24–9.64), and a high-intensity MRI signal in the herniation (p = 0.047, OR: 2.97, 95% CI: 1.03–8.87). Patients in group P had significantly higher rates of disc height decrease ≥20%, reduced herniated disc size, and improved VAS for pain, but both groups had significant decreases in pain. No cases had anaphylactic shock or neurologic sequelae.

Conclusions

These results show the safety and efficacy of chemonucleolysis with condoliase for treatment of painful LDH. Progression of Pfirrmann criteria on MRI at 3 months after injection was significantly associated with an improved clinical outcome.

中文翻译：

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腰椎间盘突出症Condoliase治疗后基于Pfirrmann标准的椎间盘退变相关因素

背景

腰椎间盘突出症（LDH）是腰痛的常见原因，与导致神经根受压的髓核变性有关。使用Condoliase进行髓核化学溶核术是 LDH 的一种低侵入性治疗方法。本研究的目的是调查 Pfirrmann 标准的变化，该标准用于评估椎间盘退变，在将安慰酶注射到突出的椎间盘后，并确定注射后 3 个月与椎间盘退变相关的因素。

方法

回顾性分析9月份以来在我中心接受椎间盘内注射溶核术的127例LDH患者（男性88例，女性39例，平均年龄：46.6±17.1岁，平均随访时间：9.8±7.8个月）的病历和影像学检查结果2018.使用21号椎间盘穿刺针将Condoliase（1.25 U/mL；1 mL体积）注射到受影响的椎间髓核中部。

结果

注射后 3 个月内 Pfirrmann 分级有进展和没有进展的病例分别被纳入 P 组（进展，n = 49）和 NP（未进展，n = 78）组。注射后 Pfirrmann 分级进展的 Logistic 回归分析显示，与年龄 <40 岁（p = 0.013，比值比 (OR)：3.69，95% 置信区间 (CI)：1.32–10.31）、Pfirrmann II 级或 III 级显着相关基线时（p = 0.021，OR：3.51，95% CI：1.24–9.64），以及疝气中的高强度 MRI 信号（p = 0.047，OR：2.97，95% CI：1.03–8.87）。P 组患者的椎间盘高度下降 ≥20%、椎间盘突出尺寸减小以及疼痛 VAS 改善的比率显着较高，但两组患者的疼痛均显着减轻。没有病例出现过敏性休克或神经系统后遗症。

结论

这些结果显示了用Condoliase进行化学溶核治疗疼痛性LDH的安全性和有效性。注射后 3 个月 MRI 上 Pfirrmann 标准的进展与临床结果的改善显着相关。