[Clinical deterioration following chemonucleolysis. Sequestration or neurotoxic complication?]

The clinical deterioration in a patient after chemonucleolysis with chymopapain is described in a case report. Experiments were carried out, to receive a proper understanding of possible diagnostic and therapeutic approaches. The paper discusses the pathophysiology of these complications from the view-points of morphology and function. In the important early differential diagnosis between sequestration and neurotoxic complication, magnetic resonance tomography and possibly also spinally evoked nerve potentials play an important role. If a sequester has formed, immediate surgery is imperative, whereas in neurotoxic complication high dosage level cortisone treatment must be performed.