Journal Article

Effects of catheter-based extradural collagenase chemonucleolysis on pain scores and lumbar function in patients with lumbar disc herniation

Feng, Yongfu, Shang, Guanfeng, Luo, Xiaoyun, Xu, Yun, Song, Guoping, Yuan, Jie, Zhang, Qian, Huang, Yuanxin

2026

Overview

Lumbar disc herniation (LDH) is a leading cause of radicular pain and disability. While conventional intradiscal collagenase chemonucleolysis (ICCN) is a minimally invasive alternative to surgery, it is limited by suboptimal drug targeting and recurrence. Catheter-based extradural collagenase chemonucleolysis (CECCN) was developed to deliver the enzyme directly to the herniated fragment. This research aimed to compare the clinical efficacy and safety of CECCN versus ICCN. A total of 300 patients with single-level, symptomatic lumbar disc herniation refractory to conservative treatment were included. The CECCN group ( = 150) consisted of patients prospectively enrolled between January 2025 and December 2025. Data for this group were provided by five centers: the Department of Pain, The Second Affiliated Hospital of Guizhou Medical University ( = 70), the Department of Pain, Affiliated Hospital of Guizhou Medical University ( = 20), the Department of Pain, Affiliated Hospital of Zunyi Medical University ( = 20), the Department of Pain, Guiyang Fourth People's Hospital ( = 20), and the Department of Rehabilitation, Tianzhu County People's Hospital ( = 20). The ICCN group ( = 150) was established through retrospective review of medical records of patients who underwent conventional ICCN at the Department of Pain, The Second Affiliated Hospital of Guizhou Medical University between January 2023 and December 2024, met the same inclusion and exclusion criteria, and completed the predefined outcome assessments at the required follow-up time points. The outcomes were operation time, hospital stay, pain severity, lumbar function, clinical efficacy, quality of life and complications. Operation time was longer in the CECCN group (  < 0.01), but hospital stay was comparable (  > 0.05). The CECCN group demonstrated significantly lower NRS scores at 7 days, 1, 3, as well as 6 months (all  < 0.05). At 3 and 6 months, the CECCN group also showed superior JOA scores (  < 0.05), lower ODI scores (p < 0.05), a higher excellent/good rate per Macnab criteria (  < 0.05), as well as better SF-36 scores (  < 0.05) relative to the ICCN group. The occurrence of complication rate presented significantly lower in the CECCN group (  < 0.05). CECCN is more effective than conventional ICCN for relieving pain, improving function and quality of life, and reducing complications in LDH patients. The superior outcomes support its role as an advanced percutaneous treatment option, despite a longer procedural time.

• Publisher: Frontiers Media SA,Frontiers Media S.A
• Subject: Back pain / Body mass index / catheter / Catheters / Enzymes / Epidural / extradural collagenase chemonucleolysis / Hospitals / Intervention / lumbar disc herniation / lumbar function / Original Research / pain / Physical therapy / Steroids / Surgery