Double-Blind Evaluation of Collagenase Injections for Herniated Lumbar Discs

Bromley, John W.; Varma, Andre O.; Santoro, Anthony; Cohen, Philip P.; Jacobs, Richard L.; Berger, Lee

doi:10.1097/00007632-198407000-00012

Cited by 32 publications

(13 citation statements)

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“…In papers comparing an intervention to placebo therapy, 23,26,30,32 the complications in the intervention group were collated and used in the analysis. Randomized controlled trial reports were only included where complications were mentioned and the complication individually identified.…”

Section: Literature Reviewmentioning

confidence: 99%

Review of Safety in Endoscopic Laser Foraminoplasty for the Management of Back Pain

Knight

Ellison

Goswami

et al. 2001

Journal of Clinical Laser Medicine & Surgery

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Section: Literature Reviewmentioning

confidence: 99%

Review of Safety in Endoscopic Laser Foraminoplasty for the Management of Back Pain

Knight

Ellison

Goswami

et al. 2001

Journal of Clinical Laser Medicine & Surgery

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“…Collagenase has also been tested in animals and found to have much lower allergic potential than does chymopapain 35. Collagenase showed an 80% success rate in 30 patients with refractory symptomatic lumbar intervertebral disc disease 8 weeks after injection when compared with placebo 36. One study of 100 patients treated with either chymopapain or collagenase showed good and excellent results in 72% and 52% of patients, respectively, at a 5-year follow-up 35.…”

Section: Introductionmentioning

confidence: 99%

Treatment of chronic low back pain – new approaches on the horizon

Knežević¹,

Mandalia²,

Raasch³

et al. 2017

JPR

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Back pain is the second leading cause of disability among American adults and is currently treated either with conservative therapy or interventional pain procedures. However, the question that remains is whether we, as physicians, have adequate therapeutic options to offer to the patients who suffer from chronic low back pain but fail both conservative therapy and interventional pain procedures before they consider surgical options such as discectomy, disc arthroplasty, or spinal fusion. The purpose of this article is to review the potential novel therapies that are on the horizon for the treatment of chronic low back pain. We discuss medications that are currently in use through different phases of clinical trials (I–III) for the treatment of low back pain. In this review, we discuss revisiting the concept of chemonucleolysis using chymopapain, as the first drug in an intradiscal injection to reduce herniated disc size, and newer intradiscal therapies, including collagenase, chondroitinase, matrix metalloproteinases, and ethanol gel. We also review an intravenous glial cell-derived neurotrophic growth factor called artemin, which may repair sensory nerves compressed by herniated discs. Another new drug in development for low back pain without radiculopathy is a subcutaneous monoclonal antibody acting as nerve growth factor called tanezumab. Finally, we discuss how platelet-rich plasma and stem cells are being studied for the treatment of low back pain. We believe that with these new therapeutic options, we can bridge the current gap between conservative/interventional procedures and surgeries in patients with chronic back pain.

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“…The clinical experience with collagenase started in the early 1980s, with success rates between 69% and 88%. 9,10,12,17,36,40 Results from a randomized double-blind dose-finding study of 20 versus 450 ABC units of collagenase in 85 patients showed a significant pain improvement in 76% of the high-dose group, as compared with 54% of the low-dose group. 62 These comparisons with other studies are as interesting as the development of the clinical outcome over 5 years for both enzymes.…”

Section: Discussionmentioning

confidence: 99%

“…7,8,28,[67][68][69] In a double-blind study, 80% of the patients treated with collagenase showed good and excellent results, as compared with 30% in the placebo group. 9 There were no reports about allergic reactions or sensitivity to collagenase, but endplate erosions of the adjacent vertebra, mimicking the picture of discitis, were reported. 10,12,36,39,40 Even 7 to 10 times the therapeutic dose injected into the disc or intravenously in dogs and monkeys caused no toxic effects.…”

mentioning

confidence: 99%