Cost and outcome comparison between intradiscal condoliase injection and surgical treatment for lumbar disc...

Intradiscal condoliase injection therapy (ICIT) is a novel minimally invasive treatment for lumbar disc herniation (LDH). We aimed to compare adverse events, outcomes, and costs of ICIT versus surgery using health claims data. From the database for the period 2020 to 2023, 1,982 ICIT, 4,009 endoscopic discectomy, and 5,528 open discectomy records were extracted. Comparing each surgical group matched to the ICIT group revealed that ICIT had a significantly lower surgical site infection incidence (vs. endoscopic, 0.6% vs. 1.4%, P = 0.016; vs. open, 0.6% vs. 2.8%, P < 0.001), whereas the incidence of additional spine surgery within 90 days was significantly higher (4.9% vs. 2.5%, p < 0.001; 4.9% vs. 1.6%, p < 0.001). The total cost of ICIT group was < 50% of that of discectomy (352,271 vs. 807,550 JPY, P < 0.001; 352,271 vs. 866,642 JPY, P < 0.001). In the first month after treatment, ICIT was associated with the least amount of analgesic prescriptions (76.1% vs. 91.2%, P < 0.001; 76.1% vs. 96.2%, P < 0.001), whereas ICIT was associated with the most in the third month (25.6% vs. 16.0%, P < 0.001; 25.6% vs. 15.7%, P < 0.001). ICIT presents a viable, low-cost treatment alternative to surgery for LDH.