[Results of percutaneous chemonucleolysis in lumbar disk hernia]

The percutaneous interventions have gained widespread acceptance for operative treatment of certain lumbar disc herniations. During recent years, percutaneous nucleotomy and laser discolysis replaced more and more the older technique of chemonucleolysis. Reports of anaphylactic shocks and severe neurological complications as well as unsatisfaction with the results of chemonucleolysis were responsible for this change. The basic mechanical concept of reduction of the intradiscal pressure remains the same with the newer methods. At the Inselspital percutaneous nucleotomy replaced chemonucleolysis in 1990. The results of chemonucleolysis were analysed with the aim of quantifying the efficiency of the percutaneous approach among our patient population. A total of 111 patients underwent chemonucleolysis between 1984 and 1989. The indication for the intervention was based on a several month history of lumbosciatica and a correlating radiological finding of disc protrusion or limited herniation. One case of anaphylaxis was the only serious perioperative complication. Upon follow-up examination approximately 2 months later, 54% of the patients were satisfied with the result, 27% reported an unchanged condition, and 19% had more pain than prior to the intervention. These results appear insufficient for an intervention associated with a non-negligible risk. Reduction of the nucleus pulposus appears often not to be an efficient mechanical concept for the treatment of disc protrusions and herniations.