Combined target-injection of collagenase by CT guided for local chemonucleolysis

Objective To study the clinical significance of the combined target-injection of collagenase by CT guided for local chemonucleolysis.Methods 462 patients with lumbar disc herniation at L1,2 to L5,S1 space were included in this study,among the cases 141 with the diameter of prominence≥10mm,15 with the lumbar disc prolapse and 15 cases with recurrent lumbar disc herniation. The operation was carried out under the CT-guided.At first,the patientlay prone on the table and accepted CT scan for localization.The puncture layer and the pathway was selected according to the CT image; Second,the percutaneous combined target-puncture under CT-guided with the double needles and the test of local anesthetic was done at the same time; Third,if no physical sign of the spinal anesthesia happened for 15-20 minutes the collagenase was respectively injected into the prominence by needle-through-needleand on the prominence.Results There were 6 cases with the miss of puncture on the first time and the successful rate of puncture was 98.8％. The excellent and good cure rate was 92.2％,and the effective rate was 97.6％ following up 5 to 24 months.The following CT scan (after operation 2 to 12 month)showed the prominence disappeared or reduced 50％-90％ in 84 of 90 patients (93.3％); little change were 6 cases.Conclusion Not only can the combined target-injection of collagenase by CT guided for local chemonucleolysis improve the clinical curative effect,but also reduce observably the size of the prominence on the CT image.It is a safe,effective,micro-traumatic and economical method for the treatment of lumbar disc herniation.