Comment on Matsuyama et al. : A clinical study of ten-year prognosis in patients with lumbar disc herniation treated with condoliase in a phase III trial.

PURPOSE: This letter comments on a 10-year follow-up study of patients with lumbar disc herniation treated with intradiscal condoliase in a phase III programme, with attention to long-term effectiveness, safety, imaging changes, and interpretive limitations.

MATERIALS AND

METHODS

We critically appraised the reported long-term clinical and imaging outcomes, focusing on participant retention, missing data, interpretation of structural disc changes, assessment of pain and disability, reintervention reporting, and causal framing in the absence of a long-term comparator.

RESULTS

The study provides valuable long-term data, with generally low disability among consenting participants and limited lumbar operations at the injected level. However, less than half of the originally treated cohort contributed long-term follow-up data, raising concerns about selection bias, survivorship bias, and nonrandom missingness. Interpretation is further limited by nonmonotonic imaging follow-up, binary pain assessment at 10 years, limited linkage between imaging progression and patient-centred outcomes, and unclear alignment between instability definitions and longitudinal change. Progressive disc height loss, Modic change, and Pfirrmann progression require cautious interpretation without clearer symptom correlation and stratified analyses.

CONCLUSIONS

The 10-year follow-up contributes important evidence on condoliase-treated lumbar disc herniation, but stronger handling of missing data, clearer reporting of time to surgery and reasons for reintervention, imaging symptom linkage, and more explicit causal framing would improve interpretability. These refinements would better guide clinicians and patients discussing long-term durability, reintervention risk, and the clinical meaning of progressive imaging change after intradiscal condoliase.