Abstract
Objective This study explored the 10-year efficacy, safety, and prognostic factors of low-dose collagenase chemonucleolysis (CCNL) combined with radiofrequency (RF) in the treatment of lumbar disc herniation (LDH). Methods The data of 167 LDH patients were collected. Modified MacNab criteria, Numerical Rating Scale (NRS), and Japanese Orthopedic Association (JOA) scores were, respectively, used to evaluate patients' excellent and good rates, pain degree, and nerve function. The preoperative and 10-year postoperative patients' pain, numbness, and muscle weakness were compared. Patients' complications in perioperative period, recurrent/reappeared LDH, and reoperations were recorded. Finally, the independent risk factors affecting the long-time efficacy were assessed. Results A total of 126 patients were included. The patients' excellent and good rates were 86.51%–92.86% with no significant difference (P > 0.05). Postoperative NRS and JOA scores significantly improved (P < 0.01), most obvious within 6 months postoperatively. At 10 years postoperatively, 65.08%, 83.95%, and 93.02% of patients' pain, numbness, and muscle weakness were completely relieved (P < 0.05). Perioperative complications occurred in three patients with the rate of 2.38%. Recurrent/reappeared LDH patients were 11 with the ratio of 8.73%; nine of them underwent reoperations with the rate of 7.14%. And patients' probability of fair and poor efficacy at 10 years postoperatively with the course of disease >12 months and the responsibility disc ≥2 were, respectively, 6.005 and 4.227 times that of patients with the course of disease ≤12 months and the responsibility disc = 1 (P < 0.05). Conclusion The combined treatment is effective and safe in the long term. A course of disease >12 months and responsibility disc ≥2 independently reduce efficacy, and a course of disease >12 months has a more significant impact.
Highlights
80% of the population experiences an episode of low back pain (LBP) at least once during their lifetime [1]
Another study confirmed that low-dose collagenase chemonucleolysis (CCNL) combined with RF was effective and safe for the treatment of cervical intervertebral disc herniation (1 year) [36]
Zhang et al [14] used low-dose CCNL combined with RF in porcine intervertebral discs, which showed that RF reduced the amount of nucleus pulposus (NP) hydrolyzed induced by CCNL, as well as the content of hydroxyproline and glycosaminoglycan
Summary
80% of the population experiences an episode of low back pain (LBP) at least once during their lifetime [1]. Lumbar disc herniation (LDH) is the most common cause of LBP and sciatica, and the mechanism of it mainly involves mechanical compression, inflammatory stimulation, immunological reaction, and pain sensitization [3,4,5]. Collagenase chemonucleolysis (CCNL) can hydrolyze the main component “collagen type II fibers” in the nucleus pulposus (NP) by collagenase. 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, relieving the compression of herniated NP on the nerve roots and dural sac [9, 10]. It is mainly used to treat contained LDH and discogenic LBP in clinic [4, 15,16,17,18]
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