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Related Concept Videos

Herniated Intervertebral Disc l: Introduction01:29

Herniated Intervertebral Disc l: Introduction

Intervertebral disc herniation refers to the displacement of the nucleus pulposus (the gel-like inner core of the disc) through a tear or weakened area in the annulus fibrosus (the outer fibrous ring). The displaced disc material extends beyond the normal boundaries of the disc space and may compress or irritate nearby spinal nerve roots or, less commonly, the spinal cord.Etiology and Risk FactorsHerniation commonly results from degeneration, in which aging reduces disc hydration and...
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Degenerative disc disease is a chronic condition in which intervertebral discs gradually lose structure and function. It is not infectious or autoimmune; rather, it results from age-related biochemical and mechanical changes, influenced by genetic, metabolic, and environmental factors.Structure and Function of DiscsThe spine contains 23 intervertebral discs that absorb load, distribute forces, maintain spacing, and allow flexibility. Each disc consists of a nucleus pulposus, a gel-like core...
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The symptoms of degenerative disc disease arise from a combination of mechanical compression, vascular compromise, and biochemical inflammation, which together disrupt nerve function and produce pain.Mechanical CompressionDisc degeneration reduces height and elasticity, predisposing to herniation of the nucleus pulposus, a major cause of radicular pain. Herniations may be protrusion (bulging with intact annulus), extrusion (nucleus extends beyond disc but remains connected), or sequestration...

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Related Experiment Video

Updated: Jul 14, 2026

Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
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Chemonucleolysis in lumbar disc herniation: a meta-analysis.

José Mauro Cardoso Couto1, Euclides Ayres de Castilho, Paulo Rossi Menezes

  • 1Department of Preventive Medicine, Medical School, São Paulo University, São Paulo, SP, Brazil.

Clinics (Sao Paulo, Brazil)
|May 17, 2007
PubMed
Summary

Chemonucleolysis effectively treats lumbar disc herniation, showing superiority over placebo and comparable results to collagenase. However, its effectiveness compared to surgery remains unclear due to study heterogeneity.

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Area of Science:

  • Neurosurgery
  • Minimally Invasive Procedures
  • Spinal Disorders

Background:

  • Lumbar disc herniation is a common cause of low back pain.
  • Chemonucleolysis offers a less invasive treatment option.

Purpose of the Study:

  • To systematically review and meta-analyze the efficacy of chemonucleolysis for lumbar disc herniation.

Main Methods:

  • Systematic review and meta-analysis of 22 clinical trials.
  • Data extracted from Cochrane Controlled Trials Register, MEDLINE, and EMBASE.
  • Statistical analysis using STATA software.

Main Results:

  • Chemonucleolysis showed a 1.51 risk ratio for pain relief versus placebo (95% CI: 1.27-1.80).
  • Chymopapain and collagenase demonstrated similar efficacy (RR 1.07; 95% CI: 0.95-1.20).
  • Chemonucleolysis with chymopapain was comparable to surgery (RR 0.93; 95% CI: 0.88-0.98), though with significant heterogeneity.

Conclusions:

  • Chemonucleolysis using chymopapain is superior to placebo and as effective as collagenase for lumbar disc prolapse.
  • Heterogeneity in studies comparing chemonucleolysis with surgery limits interpretation of comparative effectiveness.