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REVIEW article

Front. Med.
Sec. Precision Medicine
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1522568

Developments and Clinical Experiences in Collagenase Chemonucleolysis for Lumbar Disc Herniation: A Narrative Review

Provisionally accepted
Hao Zhang Hao Zhang 1Chi Zhang Chi Zhang 2*Lin Li Lin Li 1*Ming-liang Hu Ming-liang Hu 1*Jian-ning Zhao Jian-ning Zhao 3*Zhang Zheng Zhang Zheng 4*Wen-feng Ding Wen-feng Ding 1*
  • 1 Dianjiang people’s hospital of Chongqing, Chongqing, China
  • 2 Chongqing Yangjiaping Middle School, Chongqing, China
  • 3 Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
  • 4 Chongqing Kaizhou Guangming Orthopedic Hospital, Chongqing, China

The final, formatted version of the article will be published soon.

    Lumbar disc herniation (LDH) affects millions globally, with annual healthcare costs exceeding $100 billion in the US alone, driving increasing interest in minimally invasive radiological interventions as treatment alternatives. This narrative review examines developments in collagenase chemonucleolysis for lumbar disc herniation (LDH), integrating a literature analysis with clinical experience. Key advancements include the transition from single-agent to combination therapies, exploration of diverse injection routes, and the progression from C-arm fluoroscopy to multi-slice CT guidance. The synergistic use of collagenase, oxygen-ozone, and anti-inflammatory analgesics has enhanced efficacy.Safety measures such as aspiration tests, contrast agent tests, and lidocaine tests implemented to mitigate procedural risks. However, challenges persist, including non-standardized dosages and potential complications arising from intradiscal injections. Future research should focus on establishing accreditation systems, refining patient selection criteria, optimizing drug dosages, and exploring advanced image-guided technologies. While chemonucleolysis offers advantages such as minimal invasiveness and cost-effectiveness, its complexity necessitates a multidisciplinary approach. Key findings demonstrate that combination therapy achieves superior outcomes compared to monotherapy, with long-term efficacy rates reaching 90% and six-month success rates of 95%. Additionally, CT guidance has significantly improved procedural precision and safety compared to traditional fluoroscopy. This review provides insights for clinicians and researchers, highlighting the potential of chemonucleolysis in LDH management to ensure its safe and effective integration into mainstream treatment protocols.

    Keywords: Chemonucleolysis, Oxygen-ozone, collagenase, CT-guided, Lumbar disc herniation

    Received: 04 Nov 2024; Accepted: 24 Dec 2024.

    Copyright: © 2024 Zhang, Zhang, Li, Hu, Zhao, Zheng and Ding. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Chi Zhang, Chongqing Yangjiaping Middle School, Chongqing, China
    Lin Li, Dianjiang people’s hospital of Chongqing, Chongqing, China
    Ming-liang Hu, Dianjiang people’s hospital of Chongqing, Chongqing, China
    Jian-ning Zhao, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
    Zhang Zheng, Chongqing Kaizhou Guangming Orthopedic Hospital, Chongqing, China
    Wen-feng Ding, Dianjiang people’s hospital of Chongqing, Chongqing, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.