The incidence of disc herniation
Painful diseases of the cervical and lumbar spine are the most common painful diseases in clinical practice. According to the statistics of some hospitals in China, such patients account for one-fifth of the number of patients attending surgical outpatient clinics and half of the number of orthopedic outpatient clinics; some scholars estimate that, on average, for every family of five, there is one patient with neck, shoulder pain or lumbar leg pain. The statistics of Qingdao Medical College Hospital from 1958 to 1981 is that patients with neck, shoulder pain and lumbar and leg pain accounted for about 1/5-3/10 of the number of orthopedic patients, of which 78% were herniated discs. The incidence of cervical and lumbar disc herniation has continued to rise in the population in recent years, and has now reached 15.2%, with a trend toward lower age. There are many causes of cervical, shoulder, lumbar and leg pain, except for a few patients with acute trauma, most of which are caused by chronic old damage, degeneration and hyperplasia of the intervertebral disc.
According to the U.S. National Health Center, 80% of American adults suffer from neck and shoulder pain or low back pain, and cervical and lumbar disc herniation is the most common cause of the disease. Haley and Perry found cervical and lumbar disc herniation in 27.27% of routine autopsies. 15.2% of 368 autopsies by Andrae found herniated discs. 1/3 of autopsies over 40 years of age found herniated discs. A survey of patients with low back and leg pain and other pain found that 12.2% of them had disc lesions.
This shows that the incidence of herniated discs is widespread and extremely widely distributed, and a large number of patients are suffering from the disease every day due to the limitations of medical treatment, so the World Health Organization once pointed out that “the human conquest of herniated discs is far more significant than the conquest of cancer.”
Only 3-5% of patients with herniated discs are suitable for surgical treatment
The traditional treatment of disc herniation is mostly orthopedic surgery with open removal of the disc nucleus pulposus, both in the past and now, only about 3-5% of disc herniation patients need surgery, of which only 70-80% of patients can achieve the purpose of treating this disease. However, patients are afraid of surgical treatment because of the large surgical incision, extensive tissue stripping, bleeding, inevitable soft tissue damage, bone damage, disruption of spinal stability, bed rest and long postoperative recovery time, and the more common adverse effects of nerve adhesions or adhesions in the epidural space. Therefore, many patients with cervical and lumbar disc herniation desire an ideal method that is non-invasive, less invasive, less painful, quicker to recover, more effective, safe and simple.
Modern medicine reconceptualizes the pathogenesis of disc herniation
The traditional view: mechanical compression is the main cause of nerve root pain. However, it has been proven that.
1. some patients have a mild degree of disc herniation but severe clinical signs and symptoms
2. other patients have very severe lumbar disc herniation, but their clinical symptoms are mild.
3. Autopsy of traffic accident deaths found that some people had very severe disc herniation and never had discomfort in the lower back limbs.
Modern neurobiochemical and immunological studies suggest that
1, degenerative degeneration of the intervertebral disc causes disc protrusion
2. Non-bacterial and immune radiculitis secondary to disc herniation
3. disc herniation secondary to intradiscal edema and compression of nerve roots
4. Non-bacterial inflammation caused by disc herniation is closely related to the clinical manifestations, and inflammation is the main pathophysiological basis of disc herniation
5, in disc herniation, the stimulation of nerve tissue by inflammatory mediators produced by various inflammatory reactions is one of the main mechanisms of disc herniation pain
6.Clearance of inflammation is the main therapeutic goal in the treatment of disc herniation
7, only a few patients (3-5%) need surgery due to nerve root compression, resulting in mechanical injury
Degeneration of the intervertebral disc is an important cause of disc herniation, cervical and lumbar disc degeneration is caused by cervical and lumbar disc dynamics load, some people cervical and lumbar disc degeneration from youth, they have a high incidence of cervical and lumbar disc herniation. According to statistics, among many patients with disc herniation, another 90% of patients are not suitable for surgery, or have clinical symptoms but no obvious abnormalities on imaging (this is mostly due to degeneration and rupture of the fibrous ring causing inflammatory material to gather), and for a long time people often have to take the approach of enduring this lifelong pain, and opening their mouths to cry out for pain is considered immature and not strong, and a few people are also mistaken for It is a psychosomatic abnormality.
International advances in the treatment and research of herniated discs – papaya rennet
Due to modern advances in neurobiochemistry and immunology, the focus of treatment for herniated discs has shifted internationally to a non-surgical chemical approach.
Since Simith first reported the use of papaya rennet for the treatment of lumbar disc herniation in 1964, nucleus pulposus chemolysis has become a compelling approach to the treatment of lumbar disc herniation and has developed rapidly. After 30 years of animal experiments and clinical studies, the U.S. Food and Drug Administration (FDA) approved the application of papaya rennet (Chymopapain) chemolysis for the treatment of lumbar disc herniation in November 1982. Since then, this technique has been more widely used. Based on the results of double-blind studies, papaya rennet chemonucleolysis is considered safe and effective. The mechanism of treatment is that the enzyme cleaves the mucopolysaccharide from the proteoglycan, which releases water from the nucleus pulposus and dehydrates and shrinks the herniated nucleus pulposus. A large number of scholars such as Hakelius (1970), Spangfort (1972), Weber (1983), Lewis (1987) have conducted a large number of trials and clinical applications and confirmed its long-term efficacy up to 66-93%. However, because papaya rennet is prone to allergy and may cause serious adverse reactions such as paraplegia and acute transverse myelitis during the use of papaya rennet, although the incidence is low, the danger is great, and clinical observation proves that it can only dissolve 30% of the herniated tissue of the nucleus pulposus, so the medical profession has been conducting unremitting research on other enzymes to choose a safer and more effective biological enzyme.
In 1969, Dr. Sussman, a neurosurgeon at the Harvard School of Pharmacy, reported on the successful application of collagen hydrolase for the treatment of disc herniation by chemical lysis with collagenase based on in vitro lysis tests of isolated disc tissue and animal tests. The efficacy of collagenase chemolysis and comparison with surgical efficacy: Sussman was the first to report the results of intradiscal injection of collagenase in 29 patients with lumbar disc herniation in 1981, and the total effective rate was 86%. Since then, a large number of scholars in the United States and West Germany have reported their efficacy, with the efficiency rate ranging from 65-80%. 110 patients undergoing chemical nucleolysis were followed up by Lecuire for 8-12 years, with an overall excellent rate of 70%, and no further treatment was required. 1986, Weinstein made a detailed comparison between the collagenase injection and surgical groups, and the results were: the efficiency of the chemical nucleolysis group was The results were that the chemonucleolysis group was more effective than the surgical group, while the recurrence rate was lower than the surgical group. Even in the case of recurrence after chemonucleolysis, a higher success rate was achieved after a second myeloid injection. Since papaya rennet has been the focus of treatment and research for disc herniation, collagenase chemolysis is currently just entering clinical phase 3 trials in the U.S. .
China was the first to start the clinical application of collagenase therapy for herniated discs
In China, the Shanghai Institute of Pharmaceutical Industry started the experimental development of collagenase in 1973, and in 1975, domestic collagenase was first applied to clinical treatment of lumbar disc herniation. The excellent rate (healing rate + significant rate) was 75.66%±9.19% after evaluation. The results of numerous clinical studies have proved that collagenase lysis is a safe and effective minimally invasive treatment for disc herniation. Collagenase for injection was firstly awarded the national class I new drug certificate in China on August 20, 1993, and at the end of 1996, the Ministry of Health approved the official production of collagenase for injection by Anshan Second Pharmaceutical Factory (now Anshan Weibang Pharmaceutical Co., Ltd.), and in 1997, Shanghai Qiaoyuan Biopharmaceutical Co.
One of the important trends of modern surgery is the localization and minimally invasive treatment. With the rapid development of medical science and technology, the minimally invasive imaging-guided neurointerventional treatment of disc herniation, which avoids the trauma and postoperative complications of traditional orthopedic surgery, has become a hot spot and the main direction of development today.