Background & Aims

Lumbar disc herniation is a common cause of low back pain in the elderly, but it may resolve spontaneously compared to stenosis. If daily life is interfered with despite conservative treatment such as medication, consider surgical treatment. In Japan, intravertebral disc therapy is performed by condoliase-induced chemonucleolysis is a less invasive treatment for lumbar disc herniation under local anesthesia. However, it has been reported that condoliase is less effective in elderly patients, who often have degenerative disc disease, than in younger patients. The efficacy of condoliase in elderly patients has been gradually reported, but is still limited. In this study, we investigated the efficacy of intravertebral enzyme therapy using condoliase in patients treated with intravertebral enzyme therapy using condoliase at our hospital.

Methods

The indication is for patients without cauda equina symptoms, such as apparent paralysis of the lower limbs (MMT ?3) or bladder/rectal disturbances, in whom the attending physician considers condoliase appropriate. Of 26 patients who underwent intradiscal injection therapy from November 2019 to July 2023, 12 patients who were 70 years of age or older at the time of surgery and who could be followed up for at least 3 months after surgery were included. The study items were age at surgery, evaluation of renal function using eGFR, and the Denis Pain Scale (DPS) for pain transition evaluation taking into account the use of analgesics, etc. The criteria of DPS is as followed: Score 1 is no pain, score 2 is minimal pain, without using medications, score 3 is moderate pain, with occasional use of medications, score 4 is moderate to severe pain, with contact use of medications, and score 5 is severe pain, with chronic use of medications.

Results

The mean age at surgery was 75.2±5.8 years (71-91 years). 3 patients had little improvement in postoperative pain and required surgical treatment, 2 patients underwent MED, and 1 patient underwent surgery at another hospital. Mean BMI 23.5±4.0 (kg/m2), eGFR 61.8±16.0 (38~89) (mL/min/1.73m2), and DPS improved from a mean of 4.3 preoperatively to 2.3 at 3 months postoperatively. The DPS at 3 months averaged 1.6 in the 9 successful patients who ultimately did not require any further surgical treatment.

Conclusions

Among the successful patients, there was a 91-year-old with poor renal function and 75-year old with myasthenia gravis patient. Although there was residual pain, the patient’s sleep disturbance due to pain improved from the early postoperative period, and patients were highly satisfied with the treatment. Also, their family’s level of care decreased.
In a hyper-aged society, condoliase-induced chemonucleolysis may be a good treatment for lumbar disc herniation pain that can be considered before surgical treatment.

References

1) Denis F, Armstrong GW, Searls K, Matta L. Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment. Clin Orthop Relat Res. 1984;189:142-149
2) Chiba K, Matsuyama Y, Seo T, Toyama Y. Condoliase for the Treatment of Lumbar Disc Herniation: A Randomized Controlled Trial. Spine (Phila Pa 1976). 2018 Aug 1;43(15):E869-E876.
3) Takeuchi S, Hanakita J, Takahashi T, Inoue T, Minami M, Suda I, Nakamura S, Kanematsu R. Predictive Factors for Poor Outcome following Chemonucleolysis with Condoliase in Lumbar Disc Herniation. Medicina (Kaunas). 2023 Jan 30;59(2)
4) Banno T, Hasegawa T, Yamato Y, Yoshida G, Arima H, Oe S, Ide K, Yamada T, Kurosu K, Nakai K, Matsuyama Y. Condoliase therapy for lumbar disc herniation -2 year clinical outcome. J Orthop Sci. 2024 Jan;29(1):64-70.
5) Matsuyama Y, Chiba K. Condoliase for treatment of lumbar disc herniation. Drugs Today (Barc). 2019 Jan;55(1):17-23.
6) Huang Z, Xu B, Liu Y, Chen H, Cai X, Zhang L, Shen X, Li Y. The efficacy and safety of condoliase for lumbar disc herniation: a systematic review and meta- analysis. Front Pharmacol. 2023 Aug 21;14:1151998. doi: 10.3389/fphar.2023.1151998.

Presenting Author

Toshihiro Imamura

Poster Authors

Toshihiro Imamura

MD, PhD

The center for Research and Treatment of Bone and Joint Disease for workers, Kyushu Rosai Hospital

Lead Author

Topics

  • Treatment/Management: Interventional Therapies – Minor surgical procedures