A single injection in the back might be a new way to tackle a slipped or herniated disc. The injection uses a drug produced from bacteria to digest the tissue that’s ruptured out of the disc. The tissue then shrinks so it no longer compresses the nerves.
An article that appeared in the Daily Mail reported that researchers stated that the jab might be as good as surgery for a condition affecting tens of thousands of people every year. Discs are the circular pads of cartilage that lie in between the vertebrae, acting as shock absorbers. If the tough outer case of a disc ruptures, the soft inner core bulges out between the vertebrae and onto the nerves in the spinal column, triggering back pain.
These nerve fibres relay messages to and from different parts of the body, meaning a bulging disc not only causes back pain but also discomfort in the part of the body controlled by the nerve being compressed. As a slipped disc usually occurs in the lower back, which contains nerves to the lower limbs, leg pain is a common symptom. Arm pain and leg spasms can also occur. It’s more common in those aged 30 to 50, with men twice as likely to suffer.
Age-related degeneration, heavy lifting or sudden awkward movements are the main causes.Treatments include physiotherapy and painkillers, but if the back pain continues for longer than six weeks, or where there are very severe symptoms, such as muscle weakness or altered bladder functioning, an operation might be considered. Around one in ten cases will require surgery, where doctors cut away the piece of the disc causing the back problems.
The new treatment, developed by Japanese pharmaceutical company Seikagaku, is designed to have the same effects as surgery, but with a simple injection. The main ingredient of the injected drug is chondroitinase ABC, an enzyme made naturally by some bacteria. Injected into the centre of the soft disc material under general anesthetic, it dissolves the main compounds found in the inner disc — chondroitin sulphate, dermatan sulphate and hyaluronic acid. The same enzyme has previously been used to reduce scar tissue.
In a new trial in Japan involving 195 patients, half were given the bacteria jab and the rest a placebo. The former had significant improvement in leg pain after three months. The researchers say the enzyme digests only the soft material that is protruding and not the remaining functioning disc; it also has no effect on surrounding tissues such as blood vessels and nerves.
‘A single injection appears to be as effective as surgery in alleviating symptoms, which means that patients would also expect to receive benefits in the form of reduced medical costs, including surgical and hospitalisation costs,’ say the researchers. Another patient trial using the treatment is underway at the Encinitas research centre in San Diego, California.
Arthritis Research UK, which carries out research into back pain, welcomed the jab as a potentially exciting new treatment. ‘If it works, an injection to dissolve a herniated disc in order to reduce back pain is a good idea which could provide another, non-surgical option for patients,’ said a spokeswoman. ‘The approach taken by the researchers and the technology they are using looks robust, and in the future this could be a viable alternative to having an operation.’
Roger Dobson Daily Mail