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Related Experiment Videos

Repeat chemonucleolysis is safe and effective.

H van de Belt1, S Franssen, R Deutman

  • 1Department of Orthopaedics, Martini Hospital, Groningen, The Netherlands.

Clinical Orthopaedics and Related Research
|June 24, 1999
PubMed
Summary
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Second chymopapain injections for recurrent disc herniation showed good results in most patients. While some allergic reactions occurred, overall outcomes were positive, with over 89% achieving excellent or good results.

Area of Science:

  • Neurosurgery
  • Chemonucleolysis
  • Spinal Surgery

Background:

  • Recurrent disc herniation poses a significant challenge after initial treatment.
  • Chymopapain injections have been used for disc herniation, but data on repeat injections are limited.
  • Pretreatment protocols are essential to mitigate potential adverse reactions.

Purpose of the Study:

  • To evaluate the safety and efficacy of a second chymopapain injection for recurrent disc herniation.
  • To assess long-term outcomes and complication rates following repeat chemonucleolysis.
  • To analyze patient outcomes based on the Prolo scale after repeat treatment.

Main Methods:

  • Retrospective review of 85 patients undergoing a second chymopapain injection for recurrent disc herniation (1980-1996).

Related Experiment Videos

  • All patients received a 3-day pretreatment with H1 and H2 receptor blockers.
  • Follow-up included patient interviews using the Prolo scale and review of surgical outcomes.

    • Main Results:

    • No immediate sensitivity reactions were observed; however, four Type 1 and one Type 2 allergic reactions occurred after the second injection.
    • Of 66 patients receiving repeat injections at the same level, 51 (over 77%) reported excellent or good results based on the Prolo scale.
    • Four patients required surgery for persistent recurrence, with three achieving good outcomes. Three patients had successful third chemonucleolysis procedures.

    Conclusions:

    • A second chymopapain injection is a safe and effective treatment option for recurrent disc herniation, despite a low rate of allergic reactions.
    • Repeat chemonucleolysis demonstrates favorable long-term outcomes, with a high percentage of patients experiencing significant symptom relief.
    • Pretreatment with H1 and H2 receptor blockers appears to prevent immediate hypersensitivity reactions, allowing for successful repeat procedures.