Pretreatment Prognostic Factors for Intradiscal Condoliase Injection in Patients with Lumbar Disc Herniation: Insights from Clinical and MRI-Based Quantitative Analysis

<b>Background/Objectives</b>: Intradiscal condoliase injection is a minimally invasive and effective treatment option for lumbar disc herniation (LDH). However, the appropriate use, efficacy, and potential outcomes of this therapy have to be carefully considered because condoliase can only be administered once in life. The aim of this study is to identify factors that predict the efficacy of condoliase injection before treatment. <b>Methods</b>: A retrospective analysis was performed for 115 patients with LDH treated with intradiscal condoliase injection. The patients' background and MRI-based evaluations were used to measure various pretreatment parameters, including age, sex, symptom duration, comorbidity of psychological factors, disc height, herniated mass area, and contrast ratios within the disc and herniation. Clinical response was defined as a ≥50% reduction in leg pain on a numerical rating scale 3 months after treatment. Factors with significance in the univariate analysis were further examined using multivariate logistic regression. <b>Results</b>: Among the 115 patients, 73.9% had a ≥50% post-treatment pain reduction. The predictive factors for poorer outcomes included a longer symptom duration, psychological comorbidities, a smaller herniated mass size, a higher disc height, and a higher contrast ratio within the disc. No significant associations were found between the treatment efficacy and patient age or contrast ratio within the herniation. <b>Conclusions</b>: This study identified several pre-treatment factors that predict the efficacy of intradiscal condoliase injection for LDH. Treatment decisions should be made with particular attention to patients with a longer symptom duration, psychological factors, and fewer degenerative discs. The most important determinant of treatment efficacy may be how condoliase acts on the herniation mass.