| Background: Lumbar intervertebral disc herniation(LIDH) is the most common reason caused low back pain in clinic. Conservation therapy and operation in treating LIDH can't satisfying. Recently, neucleolysis with collagenase in treating Lumbar intervertebral disc herniation(LIDH) is widespread because of its micro-trauma and significant effect. The initial injection method was intradiscal injection. Now it developed into three methods of intradiscal injection^ epidural injection and intradiscal united epidural injection collagenase methods. Though, there is random and experimental in injection methods that adopted. Also, the relation between the melt extent of protrusion disc and clinic effect isn't definite. Then, application of neucleolysis with collagenase is limited. So, objectively evaluating the clinic effect and change of protrusion disc after CT review of various LIDH or definitely pathologic type treated by various injection methods of neucleolysis with collagenase is essential.Objective: To analysis and comparison the clinic effect andimage review outcome of intradiscal, epidural and intradiscal united epidural injection collagenase in treating protrusion type of LIDH. And to select the optimal injection method for clinic application.Methods: According to the various methods of injection collagenase, 103 qualified cases randomly assigned to intradiscal injection group(36 cases), epidural injection group (28 cases) and intradiscal united epidural collagenase injection group(39 cases). Follow-up by out-patient clinic physical examination, phone survey, and/or mail survey within short-term (from 15 days to one month) and long-term (after three months). 45 cases among of total were re-examined by CT scan at a mean 10.52 months after neucleolysis with collagenase. The height of the effected disc and the size of protrusion disc were observed and compared with the datum of preoperation.Results: All of the patients shows 68.9%/93.2% of success rate and valid rate respectively in the short-term. As well as 73.8%/84.5% in the long-term. Among three group, the success rate and valid rate of the intradiscal united epidural injection group is superior to the other groups. Though, there is insignificant difference among three groups(P > 0.05). Observed from the 45 patients re-examined by CT scan, Clinic effect of the melt extent of protrusion disc above moderate change and below the mild change has obvious significant difference in intradiscal united epidural injection group( P<0.01). while the other groups didn't(P > 0.05). Also, there is significant difference in the height change of the effected disc among the epidural injection group with the intradiscal injection group and the-2-intradiscal united epidural injection group, (P<0.05). Nevertheless, there is insignificant difference between the intradiscal injection group and the intradiscal united epidural injection group(P > 0.05).Conclusion: 1. It was suggested that the intradiscal, epidural and intradiscal united epidural injection collagenase for neucleolysis were effective methods in treating protrusion type of LIDH. 2. The change of effected disc CT image after neucleolysis with collagenase obviously felled behind the amelioration of clinical symptom. Though, The clinic effect of the intradiscal united epidural injection group has particular relation with the melt extent of protrusion disc. However, the other groups didn't embody the relation. 3. The height of the affected disc reduced in intradiscal and intradiscal united epidural collagenase injection groups didn't result in any side effects within follow-up time. The long-lasting effect in spinal stabilization long-term clinic effect should be study in the future. 4. From the study outcome in the clinical effect combination CT image, the intradiscal united epidural injection method can be the optimal therapy in treating protrusion type of LIDH because of selection because of undoubtedly melt function and preeminent clinic effect.
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