Age-specific Comparative Clinical Outcomes of Chemonucleolysis with Condoliase versus Microendoscopic Discectomy in Patients with Lumbar Disc Herniation

Introduction: Condoliase-based chemonucleolysis and microendoscopic discectomy (MED) are considered to be minimally invasive treatments for lumbar disc herniation (LDH). The aim of this study was to compare the clinical outcomes of both treatments, specifically focusing on whether the outcomes vary by age group. Methods: Patients with LDH who received intradiscal condoliase injections (condoliase group) or underwent MED (MED group) with 1-year follow-up were enrolled in this study. A numerical rating scale (NRS) was developed for leg and back pains. Using magnetic resonance imaging, changes in disc height and degeneration were evaluated. The data were assessed at baseline and at 3-month and 1-year follow-ups. The therapy was considered effective in patients whose NRS for leg pain improved by !50% at 1 year from baseline and for whom surgery was not required. Comparative analyses were conducted between the condoliase and MED groups and among the <20, 20-39, 40-59, and !60 year age groups. Results: In this study, a total of 345 patients (condoliase group, n=233; MED group, n=112) were enrolled. Subsequent surgery was required in 23 patients (9.9%) in the condoliase group because of the ineffectiveness of the condoliase therapy. Because of herniation recurrence, reoperation was required in five patients (4.5%) in the MED group. The efficacy rates were respectively 74.4% and 74.6% in the condoliase and MED groups, and no intergroup or age-group differences were found. The condoliase group had a significantly higher decrease in disc height when compared with the MED group (9.0% vs. 4.4%, p<0.05). Compared with the older age group, the younger age group had a greater decrease in disc height and disc degeneration; however, their recovery was better than that of the older age group. Among the age groups, the herniation reduction rate did not significantly vary. Conclusions: Condoliase and MED had equivalent 1-year outcomes, with no differences observed in efficacy across age groups. For informed decision-making, the advantages and disadvantages of each treatment must be understood.