Short-Term Outcome and Predictors of Therapeutic Effects of Intradiscal Condoliase Injection for Patients with Lumbar Disc Herniation

Nakajima, Hideaki; Kubota, Arisa; Maezawa, Yasuhisa; Watanabe, Shuji; Honjoh, Kazuya; Ohmori, Hironori; Matsumine, Akihiko

doi:10.22603/ssrr.2020-0126

Cited by 23 publications

(41 citation statements)

References 30 publications

(24 reference statements)

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“…The main finding of the present study was that calcified or ossified herniation was a risk factor for unsuccessful treatment with chemonucleolysis using condoliase. Previous studies demonstrated that 70-85% of patients achieved >50% improvement of NRS or visual analogue scale scores at 3 months after chemonucleolysis with condoliase [15,[21][22][23][24]. The present study showed that >80% of patients were classified into the G-group (without requirement for additional surgery), and that the mean NRS scores of leg pain and leg numbness significantly improved by 63.9% and 64.4%, respectively, at 3 months, which was comparable with previous reports.…”

Section: Discussionsupporting

confidence: 90%

Predictive Factors for Poor Outcome following Chemonucleolysis with Condoliase in Lumbar Disc Herniation

et al. 2022

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Background and Objectives: Condoliase, a chondroitin sulfate ABC endolyase, is a novel and minimally invasive chemonucleolytic drug for lumbar disc herniation. Despite the growing number of treatments for lumbar disc herniation, the predicting factors for poor outcomes following treatment remain unclear. The aim of this study was to determine the predictive factors for unsuccessful clinical outcome following condoliase therapy. Material and Methods: We performed a retrospective single-center analysis of 101 patients who underwent chemonucleolysis with condoliase from January 2019 to December 2021. Patients were divided into good outcome (i.e., favorable outcome) and poor outcome (i.e., requiring additional surgical treatment) groups. Patient demographics and imaging findings were collected. Clinical outcomes were evaluated using the numerical rating scale and Japanese Orthopaedic Association scores at baseline and at 1- and 3-month follow-up. Pretreatment indicators for additional surgery were compared between the 2 groups. Results: There was a significant difference in baseline leg numbness between the good outcome and poor outcome groups (6.27 ± 1.90 vs. 4.42 ± 2.90, respectively; p = 0.033). Of the 101 included patients, 32 received a preoperative computed tomography scan. In those patients, the presence of calcification or ossification in disc hernia occurred more often in the poor outcome group (61.5% vs. 5.3%, respectively; p < 0.001; odds ratio = 22.242; p = 0.014). Receiver-operating characteristics curve analysis for accompanying calcification or ossification showed an area under the curve of 0.858 (95% confidence interval, 0.715–1.000; p = 0.001). Conclusions: Calcified or ossified disc herniation may be useful predictors of unsuccessful treatment in patients with condoliase administration.

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Section: Discussionsupporting

confidence: 90%

Predictive Factors for Poor Outcome following Chemonucleolysis with Condoliase in Lumbar Disc Herniation

et al. 2022

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“…30 While it has been reported that higher rates of improvement for lower Pfirrmann classifications, 30 , 31 Oshita et al reported that condoliase appeared more effective for patients with Pfirrmann grade IV compared to grade III patients. 32 , 33 , 34 Regardless of the therapeutic effect of condoliase, we selected patients with Pfirrmann grade III, apart from one of the 12 patients in this study. However, we did not evaluate the action of condoliase on the nucleus pulposus clinically, for example, measurement of the hernia size before and after condoliase administration.…”

Section: Discussionmentioning

confidence: 99%

Histological analysis of nucleus pulposus tissue from patients with lumbar disc herniation after condoliase administration

Minamisawa,

Shirogane,

Watanabe

et al. 2024

JOR Spine

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BackgroundCondoliase is an enzyme used as a treatment for lumbar disc herniation (LDH). This enzyme degrades chondroitin sulfate (CS) in the nucleus pulposus of the intervertebral disc (IVD). However, there are cases in which symptoms do not improve, despite condoliase administration. This study reports histological analysis of lumbar disc tissue of LDH patients who underwent surgery because condoliase had no therapeutic effect.MethodsBetween March 2019 and August 2019, 12 LDH patients who underwent full endoscopic spine surgery (FESS) discectomy at the Dezawa Akira PED Clinic were the subjects of the study. There are two study groups: six cases underwent FESS after condoliase administration, while six underwent FESS without condoliase administration. The average duration from drug administration to surgery was 152 days. Herniated disc removed at surgery was evaluated by histological staining including immunohistochemistry by anti‐CS antibodies.ResultsMultiple large clusters (40–120 μm in diameter) were observed in the nucleus pulposus of those who received condoliase, but no clusters were observed in those who did not. The lumbar disc tissues, including the nucleus pulposus of recipients, were stained with anti‐CS antibodies that recognize the CS unsaturated disaccharide, but non‐administration tissue was not stained. These findings suggest that the enzyme acted on the nucleus pulposus, even in cases where symptoms were not improved by condoliase administration. Furthermore, there was no histological difference between stained images of the extracellular matrix in those who did or did not receive condoliase, suggesting that condoliase acted specifically on CS in the nucleus pulposus.ConclusionsWe demonstrated that CS in the nucleus pulposus was degraded in patients in whom condoliase did not have a therapeutic effect. Moreover, condoliase acts in human IVD without causing necrosis of chondrocytes and surrounding tissues.

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“…Previous studies have reported the real-world effectiveness of CC for LDH [3,5,6,8,9]. The efficacy rate of CC has been reported to be 62%-75% at 3 months and 77%-85% at 6 months after treatment.…”

Section: Discussionmentioning

confidence: 99%

Immediate Effectiveness of Condoliase Chemonucleolysis in Patients with Lumbar Disc Herniation who were Nonambulatory due to Leg Pain

Hagizawa,

Kamatani,

Kitaguchi

et al. 2024

Preprint

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Introduction: Surgery is often the treatment of choice for Lumbar disc herniation (LDH) with severe leg pain. This study aimed to investigate the efficacy of Condoliase chemonucleolysis (CC) in patients who were nonambulatory because of severe leg pain. Methods: A total of 58 patients who underwent CC for conservative treatment-resistant LDH were included in this study. Changes in the leg and lower back pain evaluated using the numeric rating scale (NRS) were retrospectively assessed at three time points (1 week, 1 month, and 3 months after treatment). Patients were divided into the ambulatory group (group A) and nonambulatory group (group N) based on their ambulatory status. The clinical and radiological findings including magnetic resonance images were compared between the two groups. Results: Of the 58 patients, 16 (28%) who could not walk independently because of severe leg pain were included in group N. Group N showed significantly higher mean NRS score for leg pain (NRS-LP) before treatment than group A (group N, 7.9; group A, 6.8; p = 0.009). Changes in the mean NRS-LP from pretreatment to 1 week were significantly higher in group N (group N, 5.2; group A, 3.4; p = 0.02). In group N, the mean NRS-LP decreased significantly over time, and 69% of the patients were ambulatory after 1 week, 88% after 1 month, and 94% after 3 months. Conclusions: CC provides early pain relief and can be an immediate treatment option for patients who cannot walk independently because of severe leg pain.

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Short-Term Outcome and Predictors of Therapeutic Effects of Intradiscal Condoliase Injection for Patients with Lumbar Disc Herniation

Cited by 23 publications

References 30 publications

Predictive Factors for Poor Outcome following Chemonucleolysis with Condoliase in Lumbar Disc Herniation

Predictive Factors for Poor Outcome following Chemonucleolysis with Condoliase in Lumbar Disc Herniation

Histological analysis of nucleus pulposus tissue from patients with lumbar disc herniation after condoliase administration

Immediate Effectiveness of Condoliase Chemonucleolysis in Patients with Lumbar Disc Herniation who were Nonambulatory due to Leg Pain

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