Immediate Effects, Detailed Clinical Outcomes, and Prognostic Factors of Chemonucleolysis Using Condoliase for Lumbar Disc Herniation.

Chemonucleolysis utilizing condoliase is a minimally invasive treatment for lumbar disc herniation (LDH) aimed at reducing intervertebral disc pressure and enhancing symptoms. In this study, lower limb pain was measured using the numeric rating scale (NRS) the day after treatment and 1 and 3 months after treatment. Prognostic factors were assessed, categorizing participants into an improvement group (I-group) for NRS lower limb pain scores of ≥3.5 and a non-improvement group (N-group) for scores of <3.5. This study included a total of 225 patients treated between April 2020 and March 2023. The mean age was 46.5 ± 16.5 years, with 151 males. The mean duration of illness was 6.2 ± 8.52 months. As of the day after treatment, 60 cases were classified into the I-group, 118 cases at 1 month after surgery, and 152 cases at 3 months after surgery. The disease duration before treatment was significantly shorter in the I-group at 1 (8.19 ± 8.74 [I-group] vs. 5.17 ± 8.04 [N-group] months) and 3 months (8.51 [I-group] ± 7.35 vs. 5.69 ± 8.87[N-group] months) after treatment. The comparison of baseline leg pain NRS shows a difference in leg pain NRS in the I-group when compared on the day after treatment (6.02 ± 2.64 [I-group] vs. 7.50 ± 1.79 [N-group]), 1 (5.13 ± 2.69 [I-group] vs. 7.58 ± 1.66 [N-group]), and 3 months (4.42 ± 2.70 [I-group] vs. 7.34 ± 1.77 [N-group]). Chemonucleolysis using condoliase for LDH can improve symptoms the day after treatment and can be a minimally invasive treatment to avoid surgery.

Patient outcomes for a minimally invasive approach to treat lumbar spinal canal stenosis: is microendoscopic or microscopic decompressive laminotomy the less invasive surgery?

OBJECTIVE: We performed a study to compare the severity of surgical stress between microscopic and microendoscopic decompressive laminotomy performed via a unilateral approach in patients with lumbar spinal canal stenosis (LSCS). MATERIALS AND METHODS: A total of 41 patients received decompressive laminotomy for lumbar spinal stenosis. Twenty patients received microscopic decompressive laminotomy (MDL), and 21 patients received microendoscopic decompressive laminotomy (MEDL). The pre- and postoperative Japanese Orthopaedic Association (JOA), and Visual Analogue Scale (VAS) lower leg pain scores were evaluated. The other variables studied were the length of the operation, blood loss, length of hospital stay, the reaction of the CRP and WBC levels, the dosage of non-steroidal anti-inflammatory drugs (NSAIDs) used and surgical complications. RESULTS: The clinical analyses of the surgical outcomes were evaluated after a minimum two-year follow-up. The pre-and postoperative JOA scores and VAS in the MDL and MEDL groups were statistically similar. There were statistically significant differences found between the lengths of the operation time, blood loss, length of hospital stay, the reaction of CRP, and the pain indicated by the dosage of NSAIDs. The length of the operation time was longer in the MEDL group, and the other variables were greater in the MDL group. CONCLUSIONS: The MEDL procedure is less invasive and safer than the MDL procedure. Hence, MEDL is an effective technique for treating symptomatic LSCS patients.

Effects of the water-holding capability of polyvinyl formal sponges on osteogenic ability in in vivo experiments.

In this study, dextran-coated polyvinyl formal (PVF) sponges with high water-holding capability were developed to increase the osteogenic response in the PVF sponge. The study aimed to estimate the effect of the increased water-holding capability of the sponges on osteogenic capacity at a bone defect site in the rabbit femur epiphysis. Bone formation was evaluated using radiography, microcomputed tomography (CT), and histological analysis at 2, 4, and 6 weeks after implantation. As shown by radiography and micro-CT findings, the dextran-coated PVF sponge without water-holding capability showed little bone formation at all evaluated time points. However, the dextran-coated PVF sponge with high water-holding capability showed increasing bone formation around the implant at 4 and 6 weeks after implantation. Furthermore, as shown by micro-CT quantitative analysis, the grafted PVF sponge with high water-holding capability showed significantly greater values for percentage of bone volume per total volume and mean bone mineral density compared with the grafted PVF sponge without water-holding capability at 4 and 6 weeks after implantation. These results suggest that the dextran-coated PVF sponge with high water-holding capability promoted osteogenesis in vivo. The PVF sponge might be a new biomaterial to be used as a fill material for bone defects.

Effects of water-holding capability of the PVF sponge on the adhesion and differentiation of rat bone marrow stem cell culture.

The aim of the study is to estimate the effects of the water-holding capability of the polyvinyl formal (PVF) sponges on osteogenic response in vitro experiments. The rat bone marrow stem cells (BMCs) were seeded and cultured for up to 4 weeks under static conditions in osteogenic media to evaluate the adhesion, proliferation, differentiation, and mineralization on the Dextran-coated PVF sponges with or without water-holding capability. The BMCs seeded onto the PVF sponges with water-holding capability showed more significant increases in DNA content, alkaline phosphatase (ALP) activity, osteocalcin content, and calcium deposition than those without water-holding capability. These results suggest that the Dextran-coated PVF sponges with high water-holding capability would have potential uses as both a new scaffold to bone tissue engineering and as a new biomaterial.