TY - JOUR
T1 - Disc Level–Specific outcomes of intradiscal condoliase injection for lumbar disc herniation
T2 - A multicenter retrospective study
AU - Watanabe, Kota
AU - Takahashi, Yohei
AU - Michikawa, Takehiro
AU - Takahashi, Takuya
AU - Banno, Tomohiro
AU - Sakaki, Kyohei
AU - Arai, Yoshiyasu
AU - Takano, Yuichi
AU - Eguchi, Yawara
AU - Taniguchi, Yuki
AU - Maki, Satoshi
AU - Aoki, Yasuchika
AU - Fujii, Shunichi
AU - Sakaeda, Kentaro
AU - Matsukura, Yu
AU - Akazawa, Tsutomu
AU - Minamide, Akihito
AU - Nojiri, Hidetoshi
AU - Sakai, Kenichiro
AU - Kato, Satoshi
AU - Tamai, Koji
AU - Suzuki, Hidekazu
AU - Miyagi, Masayuki
AU - Yoshii, Toshitaka
AU - Yamada, Hiroshi
AU - Kaito, Takashi
AU - Hiraizumi, Yutaka
AU - Yamagata, Masatsune
AU - Nakamura, Masaya
AU - Hosogane, Naobumi
AU - Ohtori, Seiji
AU - Hirai, Takashi
N1 - Publisher Copyright:
© 2025 The Japanese Orthopaedic Association
PY - 2026/5
Y1 - 2026/5
N2 - Background: The efficacy of intradiscal condoliase injection for lumbar disc herniation (LDH) may vary depending on the affected disc level. This is especially relevant in upper lumbar herniations, where anatomical constraints can complicate surgical treatment. Although condoliase has emerged as a less invasive option, disc-level–specific outcomes remain underexplored. Methods: This multicenter retrospective cohort study included 262 patients with LDH who underwent either intradiscal condoliase injection (CD group, n = 207) or microendoscopic discectomy (MED group, n = 55). Patients were categorized by herniation level: upper lumbar (L1/2, L2/3, L3/4) and lower lumbar (L4/5, L5/S1). The primary objective was to examine whether the effectiveness of condoliase differs by disc level. MED outcomes were included for reference. Primary outcomes included improvement in numerical rating scale (NRS) scores for leg and back pain at 1 year, responder rate (≥50 % improvement in leg pain), and reoperation rate. Intermediate-term (3–6 month) NRS data were also analyzed in a subset. Results: Condoliase demonstrated consistent efficacy across disc levels, with particularly favorable outcomes at upper lumbar levels. At L1/2–L3/4, the CD group achieved a 100 % responder rate and the greatest mean improvement in leg pain (6.9 ± 2.4). At L3/4, outcomes in the CD group were superior to those in the MED group (100 % vs. 57.1 % responder rate). At L4/5, while condoliase was effective, reference data from the MED group showed greater leg pain relief (7.2 ± 2.5 vs. 5.0 ± 2.8) and a higher responder rate (100 % vs. 81.2 %). At L5/S1, both treatments produced similar results. Improvements in low back pain were modest and comparable across levels and groups. In the subset analysis, MED showed faster early symptom relief at L4/5, but condoliase provided steady improvement over time. Conclusion: The effectiveness of condoliase injection therapy differs by disc level and appears particularly favorable at upper lumbar levels. Condoliase represents a safe, minimally invasive alternative for treating upper lumbar LDH. These findings support disc-level–based treatment selection when choosing between condoliase and surgical intervention.
AB - Background: The efficacy of intradiscal condoliase injection for lumbar disc herniation (LDH) may vary depending on the affected disc level. This is especially relevant in upper lumbar herniations, where anatomical constraints can complicate surgical treatment. Although condoliase has emerged as a less invasive option, disc-level–specific outcomes remain underexplored. Methods: This multicenter retrospective cohort study included 262 patients with LDH who underwent either intradiscal condoliase injection (CD group, n = 207) or microendoscopic discectomy (MED group, n = 55). Patients were categorized by herniation level: upper lumbar (L1/2, L2/3, L3/4) and lower lumbar (L4/5, L5/S1). The primary objective was to examine whether the effectiveness of condoliase differs by disc level. MED outcomes were included for reference. Primary outcomes included improvement in numerical rating scale (NRS) scores for leg and back pain at 1 year, responder rate (≥50 % improvement in leg pain), and reoperation rate. Intermediate-term (3–6 month) NRS data were also analyzed in a subset. Results: Condoliase demonstrated consistent efficacy across disc levels, with particularly favorable outcomes at upper lumbar levels. At L1/2–L3/4, the CD group achieved a 100 % responder rate and the greatest mean improvement in leg pain (6.9 ± 2.4). At L3/4, outcomes in the CD group were superior to those in the MED group (100 % vs. 57.1 % responder rate). At L4/5, while condoliase was effective, reference data from the MED group showed greater leg pain relief (7.2 ± 2.5 vs. 5.0 ± 2.8) and a higher responder rate (100 % vs. 81.2 %). At L5/S1, both treatments produced similar results. Improvements in low back pain were modest and comparable across levels and groups. In the subset analysis, MED showed faster early symptom relief at L4/5, but condoliase provided steady improvement over time. Conclusion: The effectiveness of condoliase injection therapy differs by disc level and appears particularly favorable at upper lumbar levels. Condoliase represents a safe, minimally invasive alternative for treating upper lumbar LDH. These findings support disc-level–based treatment selection when choosing between condoliase and surgical intervention.
KW - Chemonucleolysis
KW - Condoliase
KW - Disc level
KW - Lumbar disc herniation
KW - Microendoscopic discectomy
UR - https://www.scopus.com/pages/publications/105025412133
UR - https://www.scopus.com/pages/publications/105025412133#tab=citedBy
U2 - 10.1016/j.jos.2025.11.007
DO - 10.1016/j.jos.2025.11.007
M3 - Article
C2 - 41421858
AN - SCOPUS:105025412133
SN - 0949-2658
VL - 31
SP - 521
EP - 529
JO - Journal of Orthopaedic Science
JF - Journal of Orthopaedic Science
IS - 3
ER -