Cost-effectiveness analysis of intradiscal condoliase injection vs. surgical or conservative treatment for lumbar disc herniation

Takaki, Shu; Miyama, Hiroshi; Iwasaki, Motoki

doi:10.1080/13696998.2023.2173465

Cited by 7 publications

(5 citation statements)

References 7 publications

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“…In this study, CC improved the NRS-LP early after injection. Although no study has directly compared the results of CC and surgery, VAS at 1 week after surgical treatment was reported to be 2-3, and considering the superior cost-effectiveness of CC, it is considered a useful treatment option for LDH [14][15][16]. Additionally, CC does not require general anesthesia and should be considered for patients at risk for general anesthesia or surgery.…”

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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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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“…Notably, in the VER + group, 28.2% of patients reported little or no leg pain at 1 week and 64.1% at 1 month after CC. Cost-effectiveness studies have indicated that condoliase treatment as a rst line treatment for LDH holds medical economic and socioeconomic advantages compared to beginning from surgery or continuing with conservative treatments [21]. Thus, opting for CC before surgery makes economic sense, particularly in patients likely to show very early improvement.…”

Section: Discussionmentioning

confidence: 99%

Characteristics in patients with very early therapeutic response of condoliase chemonucleolysis for lumbar disc herniation

Kamatani,

Kitaguchi,

Kashii

2024

Preprint

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Introduction: Treatment of lumbar disc herniation (LDH) using condoliase chemonucleolysis (CC) requires more time than surgery to demonstrate therapeutic effects. This study aimed to identify patients who show significant improvement in leg pain very early after CC and to determine pretreatment factors that can predict a very early therapeutic response. Methods The study included 52 patients who underwent CC for treatment-resistant LDH. Scores for low back and leg pain measured by a numerical rating scale were assessed at four time points (1 day, 1 week, 1 month, and 3 months after CC). Patients who reported subjective pain relief the day after treatment and further exhibited an improved straight leg raising (SLR) angle compared to pretreatment were classified as “very early responders (VER).” Results Of the 52 patients, 39 (75%) were VER, and 13 (25%) were non-VER. The VER showed earlier improvement in leg pain. The VER had a significantly higher proportion of positive SLR test patients (p = 0.01) and a significantly smaller pretreatment SLR angle compared to the non-VER (VER vs. non-VER: 40.6 ± 19.0 vs. 63.1 ± 16.9, p < 0.001). There were no significant differences in the level, type, and size of LDH and the disc regression rate between the two groups. Conclusions Patients with a smaller pretreatment SLR angle are more likely to experience very early or early symptomatic relief, with a significant and sustained reduction in leg pain up to 3 months after CC treatment.

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“…The safety of condoliase treatment for postoperative LDH recurrence appears to be acceptable. Moreover, condoliase treatment is more cost-effective than surgical treatment and can be a cost-effective alternative to nonsurgical, conservative therapy [ 27 ]. Although condoliase treatment for postoperative LDH recurrence may be less effective than treatment for primary LDH, it is minimally invasive, safe, and cost-effective.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies were retrieved from three major academic databases (PubMed, Scopus, and Web of Science) using the appropriate search term combinations, including “condoliase” OR “chondroitinase ABC” OR “chondroitin sulfate ABC endolyase” AND “lumbar disc herniation.” Basic research and review articles were excluded. Ultimately, 19 articles were selected, including three randomized controlled trials [ 9 , 10 , 17 ], 14 case series [ 12 , 13 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], and two case reports [ 11 , 30 ] ( Figure 2 ). Patient demographics were examined, including age, sex, LDH level, Pfirrmann grade, efficacy rate, and post-treatment surgical rate in patients with LDH treated with 1.25 units of condoliase.…”

Section: Methodsmentioning

confidence: 99%

“…Basic research and review articles were excluded. Ultimately, 19 articles were selected, including three randomized controlled trials [9,10,17], 14 case series [12,13,[18][19][20][21][22][23][24][25][26][27][28][29], and two case reports [11,30] (Figure 2). Patient demographics were examined, including age, sex, LDH level, Pfirrmann grade, efficacy rate, and post-treatment surgical rate in patients with LDH treated with 1.25 units of condoliase.…”

Section: Literature Reviewmentioning

confidence: 99%

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Intradiscal Condoliase Injection Therapy for Recurrent Lumbar Disc Herniation: Case Series and Literature Review

Fukui,

Kamei,

Fujiwara

et al. 2023

Medicina

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Background and objectives: Although chemonucleolysis with condoliase for lumbar disc herniation (LDH) has become common, few reports have described its application in the treatment of recurrent LDH. Therefore, this study aimed to evaluate the safety and efficacy of condoliase treatment in six patients with recurrent LDH and review the available literature on condoliase treatment for LDH. Materials and Methods: Six patients (four men and two women; mean age, 64.7 years) with recurrent LDH who were treated with condoliase at our hospital between 2019 and 2022 were included. The clinical records and images of the patients were retrospectively evaluated. In addition, the available English literature on condoliase treatment for LDH was retrieved and reviewed. Results: Among the six patients included in the study, three showed >50% improvement in leg pain after treatment, which is a lower efficacy rate than that in previous reports. In addition, two patients required surgery after treatment, which is a higher rate than that in previous reports. The mean intervertebral disc height significantly decreased from 8.4 mm before treatment to 6.9 mm after treatment, consistent with the results of previous studies. None of the cases showed Modic type I changes on magnetic resonance imaging. Conclusions: Although the efficacy of condoliase treatment for recurrent LDH may be lower than that for primary LDH, this treatment was found to be safe and applicable for recurrent LDH.

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Cost-effectiveness analysis of intradiscal condoliase injection vs. surgical or conservative treatment for lumbar disc herniation

Cited by 7 publications

References 7 publications

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

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

Characteristics in patients with very early therapeutic response of condoliase chemonucleolysis for lumbar disc herniation

Intradiscal Condoliase Injection Therapy for Recurrent Lumbar Disc Herniation: Case Series and Literature Review

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