Therapeutic Effect of Condoliase on the Migrating Type of Lumbar Disc Herniation

<p>Introduction: The indication of condoliase for lumbar disc herniation (LDH) is recommended for the hernia that persisted within the posterior longitudinal ligament. However, there are cases in which precise diagnosis of herniation type, whether it penetrates the posterior longitudinal ligament or not, is difficult by magnetic resonance imaging (MRI). In this study, herniation type was classified into two types, namely, extruding type and migrating type, by the prolapse morphology based on the height of the intervertebral body (Komori classification), and therapeutic effect of condoliase was comprehensively compared between the two types of LDH.</p><p>Methods: Subjects included 26 LDH patients who were administered with condoliase injection. Among them, 17 cases of hernia (extruding type) escaped within the height of the disc and 9 cases (migrating type) escaped outside the height of the disc.</p><p>Efficacy of condoliase treatment was comprehensively analyzed by pain in the legs (visual analogue scale: VAS) and lower back (VAS), hernia spinal canal occupation rate, hernia escape area, and disc index (DI) before and 3 months after the condoliase treatment. A case with VAS improvement of lower limb pain >20 mm was defined as effective.</p><p>Results: The migrating type had substantially low pain improvement rates of legs and lower back, and prolapse area improvement rate at 3 months after condoliase treatment than the extruding type.</p><p>In migrating type, there were four cases in the effective group and five cases in the ineffective group. High intensity signal in T2-weighted image within the hernia was present in all cases in the effective group; however, the signal was only displayed in one of five cases in the ineffective group.</p><p>Conclusions: Condoliase treatment tended to be ineffective in migrating type of LDH compared to extruding type. However, the condoliase treatment may be effective even for the migrating type if high intensity signal in T2-weighted image within the hernia was displayed in MRI.</p>