The Efficacy of Condoliase for Treatment of Lumbar Disc Herniation: A Systematic Review and Meta-Analysis

Background: Lumbar disc herniation (LDH) results in significant daily activity restriction and morbidity. Even though 90% of patients initially respond well to conservative measures, complex and costly surgical procedures are sometimes indicated in certain patients. As a relatively novel treatment for LDH, Condoliase (chondroitin sulfate ABC endolyase) offers the capability to serve as a safe and effective chemonucleolysis agent for this condition. However, there is no consensus yet to objectively describe the efficacy of this treatment. Objectives: To compare the efficacy and safety of Condoliase vs placebo for the treatment of lumbar disc herniation. Methods: A meta-analysis was conducted based on PRISMA guidelines. We thoroughly searched Pubmed, Proquest, and Cochrane Library from inception up to March 2023. A total of two studies were included, divided into 7 meta-analyses, analyzed using Review Manager 5.4 software. Results: Condoliase improves ODI score (MD 5.62 [7.97,-3.27]; p<0.001; I2=95%), hernia volume (MD 99.77 [65.38, 134.17]; p<0.001; I2=95%), and intervertebral disc volume (MD -1238.32 [-1397.34, -1079.31],p<0.001; I2=96%) better than placebo. There was no difference in change of worst backpain, SF-36, and adverse effect between groups. Conclusion: Condoliase is able to improve ODI scores and pathologic changes in lumbar disc herniation compare to placebo. The adverse effect of condoliase is similar with placebo. More RCT study is needed to validate this finding. Key words: condoliase, placebo, lumbar disc herniation