Efficacy of Chemonucleolysis With Condoliase Versus Minimally Invasive Discectomy for Lumbar Disc Herniation: A Propensity Score-Matched Retrospective Cohort Study.

Abstract

Study DesignRetrospective cohort study.ObjectiveCondoliase is a chemonucleolysis for lumbar disc herniation (LDH) that enzymatically degrades herniated disc material with high specificity for chondroitin sulfate and hyaluronic acid. Few studies have compared condoliase treatment with surgical treatments. We compared the clinical outcomes of condoliase treatment and minimally invasive discectomy.MethodsPatients who received condoliase treatment or minimally invasive discectomy at single institution were included. Propensity score matching was performed to adjust for age and sex. We included 146 patients with LDH (73 per group). The Japan Orthopaedic Association (JOA) score, visual analog scale (VAS) for leg pain, and disc height and degeneration were assessed at baseline and 2 weeks, 3 months, and 1 year after treatment.ResultsThe JOA score and leg pain VAS improved significantly over time (<i>P</i> < .001, Friedman's test). Two weeks after treatment, a marked improvement in JOA score and leg pain VAS was observed in the surgery group compared with the condoliase group (<i>P</i> < .001, mixed-effects model). However, 3 months and 1 year after treatment, the differences were not significant. In contrast, disc height reduction was significantly greater in the condoliase group than in the surgery group at 3 months and 1 year after treatment (<i>P</i> < .001, mixed-effects model). Condoliase treatment was identified as an independent risk factor for progression of disc degeneration (odds ratio, 23.60; <i>P</i> = .001, logistic regression analysis).ConclusionCondoliase treatment demonstrated mid-term efficacy comparable to surgical treatment; however, it required more time for pain relief and was potentially associated with progression of disc degeneration.