BMC surgery · 2026
Efficacy and safety of low-temperature plasma ablation combined with collagenase in the treatment of lumbar disc herniation.
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Li Deng-Hui, Wu Gao-Feng, Huang Ze-Yu, Zhang Zhong-Hua
Аннотация
BACKGROUND: Lumbar disc herniation (LDH) is a common cause of radicular pain and disability. Evidence regarding the incremental effectiveness of combining plasma-based intradiscal decompression with collagenase chemonucleolysis remains limited.
METHODS: This single-center retrospective cohort study included consecutive hospitalized adults with imaging-confirmed LDH treated between July 2021 and July 2025. Patients underwent low-temperature plasma ablation alone (control group, n = 108) or plasma ablation plus intradiscal collagenase (observation group, n = 116). The primary outcomes were longitudinal Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores assessed at baseline, 1 week, 1 month, 3 months, and 6 months. Linear mixed-effects models evaluated treatment group, time, and group × time interactions after adjustment for clinical and imaging covariates. Secondary outcomes included clinically meaningful improvement, symptomatic imaging-confirmed recurrence, reintervention, perioperative characteristics, and complications. Propensity score matching and sensitivity analyses were performed.
RESULTS: VAS and ODI scores decreased over time in both groups (both time effects, P < 0.001), with significant group × time interactions for VAS (P = 0.002) and ODI (P = 0.006). At 6 months, the adjusted mean differences favored the observation group for VAS (- 0.54; 95% CI, - 0.81 to - 0.27) and ODI (- 5.10% points; 95% CI, - 7.47 to - 2.73). Six-month VAS responder rates were 91.2% and 96.3% (RR, 1.06; 95% CI, 0.98-1.13), while ODI responder rates were 83.2% and 91.6% (RR, 1.10; 95% CI, 0.99-1.22), respectively. Recurrence and reintervention were numerically less frequent in the observation group, but confidence intervals were wide and crossed 1. Overall complications occurred in 11.1% and 7.8% of patients, respectively (RR, 0.70; 95% CI, 0.31-1.59).
CONCLUSIONS: Plasma ablation combined with intradiscal collagenase was associated with modestly lower VAS and ODI scores over 6 months than plasma ablation alone. Differences in clinically meaningful response rates were not statistically significant, and low event numbers precluded firm conclusions regarding recurrence, reintervention, or comparative safety.
METHODS: This single-center retrospective cohort study included consecutive hospitalized adults with imaging-confirmed LDH treated between July 2021 and July 2025. Patients underwent low-temperature plasma ablation alone (control group, n = 108) or plasma ablation plus intradiscal collagenase (observation group, n = 116). The primary outcomes were longitudinal Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores assessed at baseline, 1 week, 1 month, 3 months, and 6 months. Linear mixed-effects models evaluated treatment group, time, and group × time interactions after adjustment for clinical and imaging covariates. Secondary outcomes included clinically meaningful improvement, symptomatic imaging-confirmed recurrence, reintervention, perioperative characteristics, and complications. Propensity score matching and sensitivity analyses were performed.
RESULTS: VAS and ODI scores decreased over time in both groups (both time effects, P < 0.001), with significant group × time interactions for VAS (P = 0.002) and ODI (P = 0.006). At 6 months, the adjusted mean differences favored the observation group for VAS (- 0.54; 95% CI, - 0.81 to - 0.27) and ODI (- 5.10% points; 95% CI, - 7.47 to - 2.73). Six-month VAS responder rates were 91.2% and 96.3% (RR, 1.06; 95% CI, 0.98-1.13), while ODI responder rates were 83.2% and 91.6% (RR, 1.10; 95% CI, 0.99-1.22), respectively. Recurrence and reintervention were numerically less frequent in the observation group, but confidence intervals were wide and crossed 1. Overall complications occurred in 11.1% and 7.8% of patients, respectively (RR, 0.70; 95% CI, 0.31-1.59).
CONCLUSIONS: Plasma ablation combined with intradiscal collagenase was associated with modestly lower VAS and ODI scores over 6 months than plasma ablation alone. Differences in clinically meaningful response rates were not statistically significant, and low event numbers precluded firm conclusions regarding recurrence, reintervention, or comparative safety.