Medium to long-term functional outcome of patients after chemonucleolysis

Chemonucleolysis is an established modality in the treatment of lumbar disc prolapse and has been widely used for over 39 years since its introduction by Lyman Smith in 1963. We report the medium to long-term functional outcome of patients who had chemonucleolysis for single level disc prolapse. One hundred and twelve patients were reviewed retrospectively with a mean follow-up of 9.5 years. The Oswestry Disability Index questionnaire was used to estimate the functional outcome of chemonucleolysis. An excellent or good response occurred in 79 patients (70.5%) while 12 patients (10.7%) showed moderate response with minimal disability. Treatment failed in 21 patients (18.5%) who showed poor response and 12 of these 21 patients went for surgery within a mean period of 6 months. One patient had surgery at a different level than chemonucleolysis. There was only one incident of procedure termination because of epidural contrast leak. There was no case of anaphylaxis or discitis. We concluded on the basis of our results that in carefully selected patients, chemonucleolysis is a safe and effective treatment modality for lumbar disc herniation with good medium to long-term functional outcome.