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Bone scan and chemonucleolysis.

S Amico1, J P Eschard, J C Liehn

  • 1Department of Nuclear Medicine, Institut Jean Godinot, Reims, France.

Clinical Nuclear Medicine
|December 1, 1990
PubMed
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Chemonucleolysis (CN) using chymopapain for herniated lumbar discs does not cause bone lesions. Bone scans show abnormal uptake, termed chemical discitis, which differs from bacterial spondylitis.

Area of Science:

  • Orthopedics
  • Radiology
  • Biochemistry

Background:

  • Herniated lumbar discs are a common cause of low back pain.
  • Chemonucleolysis (CN) is a minimally invasive treatment option for herniated lumbar discs.
  • Chymopapain is the proteolytic enzyme used in chemonucleolysis.

Purpose of the Study:

  • To evaluate the effects of chemonucleolysis on bone scanning results.
  • To determine if chymopapain induces bone lesions in adjacent vertebral plates.
  • To differentiate bone scan patterns of chemical discitis from bacterial spondylitis.

Main Methods:

  • Bone scans were performed on 20 patients before and after chemonucleolysis for herniated lumbar discs.
  • Chymopapain was administered as part of the chemonucleolysis procedure.

Related Experiment Videos

  • Bone scan findings were analyzed for uptake patterns in vertebral plates.

    • Main Results:

    • Chemonucleolysis with chymopapain did not result in early or late bone lesions of adjacent vertebral plates.
    • Abnormal bone scan uptake in vertebral plates was identified as "chemical discitis."
    • The bone scan pattern of chemical discitis was distinct from that observed in bacterial spondylitis.

    Conclusions:

    • Chemonucleolysis is safe concerning bone lesion induction.
    • Bone scintigraphy can help differentiate chemical discitis from infectious spondylitis.
    • Chymopapain does not appear to cause long-term bone damage in treated patients.