Factors associated with disc degeneration based on Pfirrmann criteria after condoliase treatment for lumbar disc herniation.
J Orthop Sci
; 28(5): 976-983, 2023 Sep.
Article
em En
| MEDLINE
| ID: mdl-36030156
ABSTRACT
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Dor Lombar
/
Degeneração do Disco Intervertebral
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Disco Intervertebral
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Deslocamento do Disco Intervertebral
Tipo de estudo:
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
J Orthop Sci
Ano de publicação:
2023
Tipo de documento:
Article