Factors associated with disc degeneration based on Pfirrmann criteria after condoliase treatment for lumbar disc herniation

Kobayashi, Kazuyoshi; Sato, Koji; Ando, Tsutomu

doi:10.1016/j.jos.2022.08.001

Cited by 7 publications

(14 citation statements)

References 24 publications

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“…We initially retrieved 202 ( Figure 1 ) and deleted 96 duplicate articles. A total of 10 articles were included in this study through screening ( Chiba et al, 2018 ; Matsuyama et al, 2018 ; Ishibashi et al, 2020 ; Nakajima et al, 2020 ; Hirai et al, 2021 ; Inoue et al, 2021 ; Okada et al, 2021 ; Banno et al, 2022 ; Kobayashi et al, 2022 ; Oshita et al, 2022 ).…”

Section: Resultsmentioning

confidence: 99%

“…The included studies included two RCT ( Chiba et al, 2018 ; Matsuyama et al, 2018 ), two prospective ( Inoue et al, 2021 ; Banno et al, 2022 ), and six retrospective studies ( Ishibashi et al, 2020 ; Nakajima et al, 2020 ; Hirai et al, 2021 ; Okada et al, 2021 ; Kobayashi et al, 2022 ; Oshita et al, 2022 ). A placebo was used as a control group in both RCT studies.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, condoliase can specifically degrade proteoglycan-rich NP tissues, whereas the surrounding tissue remains largely unaffected ( Ishibashi et al, 2019 ). The drug regulatory authority in Japan approved condoliase for the treatment of LDH in 2018, and multiple clinical trials have shown its safety and efficacy ( Chiba et al, 2018 ; Matsuyama et al, 2018 ; Nakajima et al, 2020 ; Hirai et al, 2021 ; Inoue et al, 2021 ; Okada et al, 2021 ; Banno et al, 2022 ; Kobayashi et al, 2022 ; Oshita et al, 2022 ). Intradiscal injection of condoliase may help patients to return to society sooner.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The efficacy and safety of condoliase for lumbar disc herniation: a systematic review and meta-analysis

Huang,

Xu,

Liu

et al. 2023

Front. Pharmacol.

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Background: Chemonucleolysis is a minimally invasive treatment of lumbar disc herniation (LDH). However, the low specificity of the enzyme and the existence of serious adverse events limit the application of chemonucleolysis. Clinical studies in recent years have shown that Chondroitin sulfate ABC endolyase (condoliase) is a potential therapeutic enzyme for LDH. Aim. A meta-analysis was conducted to determine the efficacy and safety of condoliase in LDH treatment.Methods: We searched Web of Science, Embase, PubMed, and Cochrane Library databases. Two reviewers independently screened articles, extracted data, and assessed the risk of bias. The outcomes were the total effective rate, Oswestry Disability Index (ODI) score change, the proportion of lumbar surgery after condoliase treatment, herniated mass volume change, Pfirrmann grade change, and adverse events. Review Manager 5.3 and Stata 12.0 were used for meta-, sensitivity, and bias analysis.Results: Ten studies were included. A single-arm meta-analysis showed that the total effective rate was 78% [95% confidence interval (CI) 75%–81%], the proportion of surgery was 9% (95% CI 7%–12%), the proportion of Pfirrmann grade change was 43% (95%CI 38%–47%), and the adverse events were 4% (95% CI 2%–6%) after condoliase treatment. The two-arm meta-analysis showed that the ODI score change [standardized mean difference (SMD) −2.46, 95% CI −3.30 to −1.63] and the herniated mass volume change (SMD −16.97, 95% CI −23.92 to −10.03) of the condoliase treatment group were greater than those of the placebo control group, and there was no difference in adverse events between the two groups (OR 1.52, 95% CI 0.60–3.85). The results of sensitivity and publication bias analyses showed that the results were robust.Conclusion: Condoliase intradiscal injection has excellent eutherapeutic and safety for LDH, thus, has considerable potential as a treatment option besides conservative treatment and surgical intervention for LDH.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022375492, PROSPERO (CRD42022375492).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The efficacy and safety of condoliase for lumbar disc herniation: a systematic review and meta-analysis

Huang,

Xu,

Liu

et al. 2023

Front. Pharmacol.

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“…Previous studies were retrieved from three major academic databases (PubMed, Scopus, and Web of Science) using the appropriate search term combinations, including “condoliase” OR “chondroitinase ABC” OR “chondroitin sulfate ABC endolyase” AND “lumbar disc herniation.” Basic research and review articles were excluded. Ultimately, 19 articles were selected, including three randomized controlled trials [ 9 , 10 , 17 ], 14 case series [ 12 , 13 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], and two case reports [ 11 , 30 ] ( Figure 2 ). Patient demographics were examined, including age, sex, LDH level, Pfirrmann grade, efficacy rate, and post-treatment surgical rate in patients with LDH treated with 1.25 units of condoliase.…”

Section: Methodsmentioning

confidence: 99%

Intradiscal Condoliase Injection Therapy for Recurrent Lumbar Disc Herniation: Case Series and Literature Review

Fukui,

Kamei,

Fujiwara

et al. 2023

Medicina

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Background and objectives: Although chemonucleolysis with condoliase for lumbar disc herniation (LDH) has become common, few reports have described its application in the treatment of recurrent LDH. Therefore, this study aimed to evaluate the safety and efficacy of condoliase treatment in six patients with recurrent LDH and review the available literature on condoliase treatment for LDH. Materials and Methods: Six patients (four men and two women; mean age, 64.7 years) with recurrent LDH who were treated with condoliase at our hospital between 2019 and 2022 were included. The clinical records and images of the patients were retrospectively evaluated. In addition, the available English literature on condoliase treatment for LDH was retrieved and reviewed. Results: Among the six patients included in the study, three showed >50% improvement in leg pain after treatment, which is a lower efficacy rate than that in previous reports. In addition, two patients required surgery after treatment, which is a higher rate than that in previous reports. The mean intervertebral disc height significantly decreased from 8.4 mm before treatment to 6.9 mm after treatment, consistent with the results of previous studies. None of the cases showed Modic type I changes on magnetic resonance imaging. Conclusions: Although the efficacy of condoliase treatment for recurrent LDH may be lower than that for primary LDH, this treatment was found to be safe and applicable for recurrent LDH.

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“…Chondolyase injection may be associated with increased degeneration in initially Pfirrmann 10 grade 2 or 3 discs, according to an investigation into chemonucleolysis treatment‐related factors that may contribute to disc degeneration 11 . An additional study conducted by the same author documented that chemonucleolysis treatment led to Pfirmann grade progression in 61.5% of patients within 3 months 12 .…”

Section: İntroductionmentioning

confidence: 99%

Tracing the disc: The novel qualitative morphometric MRI based disc degeneration classification system

Soydan,

Bayramoglu,

Urut

et al. 2024

JOR Spine

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BackgroundThis study aimed to develop a classification system for lumbar disc degeneration using routine magnetic resonance images (MRIs) that is easily applicable and unaffected by existing classifications' limitations, and to compare its reliability, reproducibility, and discriminative power to the widely used Pfirrmann classification.MethodsFive features were graded. This new classification system has eight grades, with at least one of these five features altering each grade. The T2‐weighted sagittal images were acquired using a rapid spin‐echo sequence with a repetition time of 2680 to 4900 milliseconds, an echo time of 100 to 109 milliseconds, and an echo train length of 17. Slice thick was 4 mm and the display field of view was 32 × 32 cm. The new classification system used five features: signal intensity, disc height, disc boundary regularity, and nucleus annulus separation. Increased signal intensity, decreased height, decreased regularity, and decreased nucleus‐annulus separation indicated degeneration. Four raters classified 400 discs from 80 patients using the Pfirrmann and Novel systems. Statistical analyses were conducted to investigate reliability and correlation.ResultsThe overall ICC and kappa values were found to be higher in the novel classification. (0.988 indicating excellent agreement for ICC and 0.76/0.94 indicating good–very good agreement for kappa). The Kendall tau c value, which shows the correlation between the two classifications and indicates the validity of the new classification, was 0.872, which is very strong. Through the use of cross‐tabulations, the discriminatory power of the two newly added classification criteria was determined.ConclusionsThis study demonstrates the intra‐rater and inter‐rater reliability of an easy‐to‐use, discriminative novel morphometric MRI based classification system for lumbar disc degeneration. The differentiation of grades based on five distinct criteria may generate novel hypotheses regarding treatment selection and response monitoring, as well as new insights into the study of disc degeneration.

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Factors associated with disc degeneration based on Pfirrmann criteria after condoliase treatment for lumbar disc herniation

Cited by 7 publications

References 24 publications

The efficacy and safety of condoliase for lumbar disc herniation: a systematic review and meta-analysis

The efficacy and safety of condoliase for lumbar disc herniation: a systematic review and meta-analysis

Intradiscal Condoliase Injection Therapy for Recurrent Lumbar Disc Herniation: Case Series and Literature Review

Tracing the disc: The novel qualitative morphometric MRI based disc degeneration classification system

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