Surgical experience following intervertebral discolysis with collagenase

Abstract

Of 410 patients with refractory herniated lumbar disc disease treated with intradiscal collagenase, 82 (20%) did not respond to enzyme treatment and subsequently underwent surgery. Failure to improve in 6 to 8 weeks was the predominant cause for surgical intervention (53 patients). Increased pain (18 patients), progressing neurological deficit (10 patients), and disc-space infection (one patient) were the other indications for surgery. At surgery, extrusions and/or sequestrations were found in 46 patients, undigested protrusions in 16 patients, and other causes of treatment failure in 14 patients. Six patients had normal findings. There was no evidence of adverse enzyme activity on the surrounding structures. Surgical results showed an overall success rate of 87%, and did not appear to be compromised by the previous enzyme therapy.

CT-Guided Chemonucleolysis Combined with Psoas Compartment Block in Lumbar Disc Herniation: A Randomized Controlled Study

“…The published data showed that the success rate of collagenase for the treatment of LDH was only from 70% to 75% [20,21]. Postoperative pain of collagenase injection has been reported in many studies [10,22,23]. Brown et al.…”

“…The published data showed that the success rate of collagenase for the treatment of LDH was only from 70% to 75% [20,21]. Postoperative pain of collagenase injection has been reported in many studies [10,22,23]. Brown et al [24] theorized that the postoperative pain is the result of a breakdown in the collagen fibers of the nucleus pulposus, thus allowing increased swelling pressure of the disc matrix, causing secondary chemical radiculitis.…”

“…However, 10% were unchanged, and 8% were worse after chemonucleolysis [6]. Collagenase is widely used in China [7,8], and the postoperative pain of collagenase injection has been reported [7,9]; it often occurs from 3 to 4 days after surgery and usually last about 1 week [10]. It not only increases the suffering of the patients but also affects the physician's confidence.…”

Low-Dose Collagenase Chemonucleolysis Combined with Radiofrequency in the Treatment of Lumbar Disc Herniation: A 10-Year Retrospective Study

“…It degrades collagen type II fibers into amino acids and destroys the NP tissue framework, so that NP tissue is dissolved, absorbed, and shrunk, causing the volume of prominent NP to shrink or even disappear, thus relieving the compression of herniated NP on the nerve roots and dural sac [ 9 , 10 ]. Since 1970s, CCNL has been used in the clinical treatment of herniated, prolapsed, and dislocated LDH for more than 40 years [ 11 – 14 ]. Currently, radiofrequency (RF) mainly reduces the pressure in the intervertebral disc or herniation by directly denaturing the protein, deconstructing the molecule in NP, and shrinking the NP tissue due to the thermal effect caused by molecular resonance caused by RF electric field.…”

“…Although the two methods have achieved good clinical effects in the treatment of LDH and discogenic LBP, the associated risks [ 19 ], such as aggravated pain, nerve root injury and adverse publicity, disc space infection, anaphylaxis, and cauda equina syndrome (CES), have limited their application and development [ 20 – 24 ], while other studies thought these methods were relatively safe [ 10 , 11 , 25 ]. A study based on the efficacy and safety of CCNL and chymopapain in the treatment of LDH suggested that CCNL may need further study and cannot be recommended at that time [ 26 ].…”