Hernicore®

This is a treatment in which an enzyme(Condoliase)-containing drug (Hernicore®) is injected directly into the intervertebral disc to shrink the nucleus pulposus of the disc, the source of the herniation, thereby reducing the pressure on the nerves. At present, this therapy has been approved only in Japan. The nucleus pulposus is rich in components that retain water. When injected, condoliase, the active ingredient in Hernicore®, breaks down these components in the nucleus pulposus and relieves the swelling caused by water. As a result, pressure on the nerves is reduced, and symptoms such as pain and numbness can be alleviated.

The standard method of treating hernias in our hospital is endoscopic procedures, such as MED (Microendoscopic Discectomy) and FED  (Full Endoscopic Discectomy). In endoscopic surgery, the protruding hernia is directly removed while viewing the endoscopic image. In principle, our group performs endoscopic procedures under general anesthesia. Although it varies from person to person, a surgical wound is made, and the patient will experience pain in the wound area for a while. In addition, hospitalization for at least three days is required. Hernicore®, on the other hand, is performed under local anesthesia, and the wound is about the size of a needle hole and is hardly noticeable. It is a one-day procedure in principle, and the patient can return home on the day of treatment.
However, Hernicore® is not suitable for people with allergies, as it can induce an anaphylactic reaction. Furthermore, the disadvantages are that the types of hernia indicated for this treatment are limited, and that because the part of the hernia that is compressing the nerve is not directly removed, the efficacy rate is lower than that of endoscopic spine  surgery.

In our group, the results of treatment in young patients are excellent. It can also be effective in treating cases with T2 hyperintensity in the prominent nucleus pulposus and relatively large hernias with spinal canal occupancy of 40% or more.

These MRI images show the changes before and after treatment in a 37-year-old male. Before the procedure, a large hernia was compressing the nerve, but after being treated, the hernia had shrunk and the pressure on the nerve had been reduced.

Our group has administered Hernicore® therapy to more than 100 patients from August 2018. There have been no adverse events to date. We participated in the clinical trials conducted by the distributors, Seikagaku Corporation and Kaken Pharmaceutical, which demonstrated certain efficacy and safety.