Five-year results from chemonucleolysis with chymopapain or collagenase: a prospective randomized study

Area of Science:

• Minimally Invasive Spine Procedures
• Interventional Pain Management
• Enzymatic Disc Therapies

Background:

• Chemonucleolysis is an established intradiscal therapy for contained disc herniations.
• Chymopapain is the longest-standing enzymatic agent used in intradiscal therapy.
• Comparing chymopapain with other agents like collagenase is crucial for treatment selection.

Purpose of the Study:

• To prospectively compare the 5-year efficacy of chymopapain versus collagenase for intradiscal injection.
• To evaluate long-term outcomes and safety profiles of these two enzymatic agents.
• To determine the optimal enzymatic therapy for contained disc herniations.

Main Methods:

• A 5-year follow-up of a prospective randomized study involving 100 patients.
• Patients were randomized to receive either chymopapain (4000 IU) or collagenase (400 ABC units) via double-needle technique under general anesthesia.
• Injections were performed at L4-L5 and L5-S1 levels, with patient age averaging 35.5 (chymopapain) and 38 (collagenase) years.

Main Results:

• After 5 years, 72% of the chymopapain group achieved good/excellent results versus 52% in the collagenase group.
• Mean pain scores decreased from 8.5 to 0.7 (chymopapain) and 8.6 to 0.9 (collagenase).
• Microdiscectomy was required for 9 patients in the chymopapain group and 14 in the collagenase group.

Conclusions:

• Chymopapain showed sustained safety and effectiveness over 5 years, with only one minor anaphylactic reaction.
• Collagenase efficacy requires further investigation, and it is not recommended at this time.
• No deterioration in outcomes was observed between 1-year and 5-year follow-ups for chymopapain.