[Evaluating performance in lumbar intervertebral disk damage following chemonucleolysis]

In spite of the good or excellent long-term results in 60% to 80% of the cases reported in the literature, the efficacy of the less invasive percutaneous nucleolysis in the treatment of therapy-resistant lumbar compression of the nerve root in patients with lumbar disk protrusion still remains controversial. On the one hand, there is discussion about the actual effectiveness of the enzymes injected and their local activity in bringing about the desired long-lasting nerve-root decompression. On the other hand, the presumed advantage of he method is questioned. It is said that postoperative morbidity is decreased and shortened, and that job rehabilitation is faster, especially with people performing hard physical work. More recently, the same can be said for the much-vaunted method of percutaneous automated diskectomy and nucleotomy. It was only possible to use these less invasive treatment techniques with approx. 10% of the author' patients with therapy-resistant lumbar compression syndromes of the nerve root caused by disk protrusion. In 85% of all patients treated, CNL produced a good or satisfactory result as regards the relief of sciatica and neurological disturbances. These long-term results cannot be transferred to job-rehabilitation results, as a critical review of 133 cases has shown. The authors were able to examine 108 of the 133 patients approx. one year after nucleolysis. In the group of businessmen, government officials, white-collar workers, and students, there was a correlation between long-term neurological results and job rehabilitation.(ABSTRACT TRUNCATED AT 250 WORDS)