Study On The Relationship Between Effect Of Collagenase Chemonucleolysis For Treatment Of Lumbar Disc Herniation And CT Number Of The Hernial Disc

Collagenase chemonucleolysis is one of the most effective methods for the treatment of lumbar disc herniation (LDH). In China, there are so many patients with LDH received the treatment of collagenase chemonucleolysis every year. But it has not an objective index to predict the curative effect of collagenase chemonucleolysis. We considered CT number of the hernial disc as an objective index for prognosis of collagenase chemonucleolysis.Objective: 1. Observing the contribution of collagenase on the hernial intervertebral disc with different computerized tomography number (CTnumber) in vitro. 2. Exploring the relationship between the curative effect of collagenase chemonucleolysis for patients with lumbar disc herniation and the CT figures of the hernial disc. Exploring the feasibility of CT number as an objective index for prognosis of collagenase chemonucleolysis.Methods: Laboratory experiment: 25 patients with LDH received CT examination before surgical operation. The models of the machine is PICK 6000 and the parameters of the thin slice scan included rated voltage 130kv, slice thickness 3mm, inter slice distance 2mm. In the disc image, three positions of the hernial intervertebral disc were chosen to measure the CT number and the mean value was recorded. The hernial intervertebral disc tissue was picked from the patients with LDH who received the surgical operation, then put these intervertebral disc tissue into DMEM until the experiment were finished. Also some works should be prepared before the experiment. First, use PBS to wash the hernial intervertebral disc and any cartilaginous or vascular regions carefully removed. Then cut each intervertebral disc into two pieces in super clean bench, each piece weighted about 0.1-0.15g. Then put them into the 24 holes culture medium and added 0.5 culture fluid to each hole. One of the two pieces wasnamed group A, the other piece was named group B. Group A was trial group which added 0.5ml culture medium and 0.5ml 400U/ml collagenase. Group B was control group which added 0.5ml culture medium and 0.5ml 0.9% saline. Then put the two groups into 37°C calorstat. Each group was divided into two groups according to CT number which was infra 90 (AK Bl) or exceed 90 (A2n B2). Both group A and group B were placed into 5 % CO2 37°C constant temperature incubator. Compare the wet weight of the intervertebral disc tissue at Oh, 24h, 48h, 72h. And observe the difference of the curative effect of collagenase chemonucleolysis between the two groups. The group B of the intervertebral disc tissue was made into paraffin section, which was stained with HE to be observed the morphologic difference between group Bl and B2.Clinical trial: 100 patients with LDH accepted collagenase chemonucleolysis, 56 males and 44 females. Their ages were between 22 and 76 years, the average was 53.1 years. The course of disease was between 1 day and 10 years. 42 of the 100 patients were L4~5 intercalated disc hernia, the other 58 patients were L5~S1 intercalated disc hernia, and the curative effect was evaluated 6 moths later. The 100 patients with LDH were divided into 2 groups according to the scatter plot of CT numbers and curative effect which were ^90, >90. The logistic regression analysis was used to observe the relationship between CT number of the hernial interverterbral disc, age, gender, body weight, case history, the position of hernial intervertebral disc and the curative effect.Results:The laboratory experiment results: Statistic analysis indicates that there was significant difference between the trial group and control group on the wet weights. Both group A and group B were degenerative intervertebral disc tissue, so we believedthat collagenase could resolve the degenerative intervertebral disc tissue. The wet weight of group Al was also different with group A2. With the collagenase, the resolve of the intervertebral disc tissue of group Al was more efficient than group A2. Light microscopical study revealed that 25 intervertebral disc tissues were all degenerated variously, such as hyaline degeneration, mutinous degeneration, calcareous infarct. The intervertebral disc tissue of group B2 was more degenerative than group Bl.Results of clinical trial: There were negative correlation between the CT numbers of the hernia! disc and curative effect. The difference of effective rate in the two groups was significant (OR = 9.403, P=0.001), the effective rate of group ^=90 were higher than group >90. There were no correlation between age, gender, body weight, case history, the position of hernial intervertebral disc and curative effect.Conclusion: 1. Collagenase could effectively resolve the degenerative intervertebral disc tissue. The efficiency of collagenase was lower as the intervertebral disc tissue being more degenerative. 2. The curative effect of collagenase chemonucleolysis was correlative with CT numbers of the hernial disc .The effect rate was higher as CT numbers of the hernial disc decreasing. 3. CT number of the hernial intervertebral disc can be one of the objective indexes for prognosis of collagenase chemonucleolysis.