Low-does Collagenase Chemonucleolysis Combined With Radiofrequency In The Treatment Of Lumbar Disc Herniation

ObjectiveThis study aims to explore the 10-year efficacy,safety and risk factors affecting the efficacy of low-dose collagenase chemonucleolysis(CCNL)combined with radiofrequency(RF)in the treatment of lumbar disc herniation(LDH).MethodsThe data of 167 patients with LDH who underwent low-dose CCNL combined with RF from June 2009 to June 2010 in the Pain Department of the First Affiliated Hospital of Nanchang University were collected.The modified Mac Nab was used to evaluate the excellent and good rate of patients at 3,6 and 120 months postoperatively.Numerical Rating Scale(NRS)and Japanese Orthopedic Association(JOA)were used to evaluate patients’ pain degree and nerve function(preoperatively;immediately postoperatively;discharge;and 3,6 and 120 months postoperatively),because patients had to lie supine on a bed for 7-10 days postoperatively,there was no JOA evaluation at immediately postoperatively.The preoperative and 10-year postoperative pain,numbness and muscle strength of patients were compared.Patients’ complications in perioperative period,recurrence or reappeared LDH and reoperation were recorded.Finally,univariate and multivariate analysis were performed to obtain the independent risk factors affecting the long-time efficacy.Results1.A total of 128 patients were followed up at 10 years postoperatively while 2patients were excluded because they died of other causes,so 126 patients were included.2.The excellent and good rate of patients at 3,6,120 months postoperatively were 86.51%,92.86%,87.30% with no significant difference(P > 0.05).Postoperative NRS and JOA were significantly improved compared with that of preoperatively(P < 0.01).Most obvious were within 6 months postoperatively because the NRS and JOA scores at each follow-up time were significantly improved compared with those at the previous follow-up time(P < 0.01).However,there was no significant difference in NRS and JOA at 120 months postoperatively compared with that at 6 months postoperatively(P > 0.05).At 10 years postoperatively,65.08%,83.95% and 93.02% of patients’ pain,numbness and muscle weakness,respectively,were completely relieved(P < 0.05).3.Three patients occurred perioperative complications with the rate of 2.38%,one of them had cauda equina syndrome(CES),the other two occurred aggravated low back pain(LBP).Recurrent or reappeared LDH patients were 11 with the ratio of8.73% during 20-114 months postoperatively,two of them underwent conservative treatments,nine patients underwent reoperation with the rate of 7.14 %.4.Binary Logistic Regression Analysis showed that the probability of fair and poor efficacy at 10 years postoperatively of patients with course of disease > 12 months and responsibility disc number ≥ 2 was respectively 6.005 and 4.227 times that of patients with course of disease ≤ 12 months and responsibility disc number =1(P < 0.05).ConclusionLow-dose CCNL combined with RF is a safe and effective method for the treatment of LDH,with good and stable long-term efficacy and no serious complications.Course of disease > 12 months and responsibility disc number ≥ 2were independent risk factors affecting the long-term efficacy,and course of disease >12 months had a more significant impact on the long-term efficacy.