Chymopapain chemonucleolysis versus surgical discectomy in a military population

From 1983 to 1987, 100 consecutive patients with lumbar herniated nucleus pulposus were treated with either chymopapain chemonucleolysis (51 patients) or surgical discectomy (49 patients). The chymopapain-treated group was followed for an average of 16 months and the surgically treated group was followed for an average of 12 months. All patients had to be candidates for both procedures and were grouped for therapy based on their preference. The groups were similar in military duty status, history, age, gender, duration and character of symptoms, physical findings, and computed tomography/myelogram results. Satisfactory outcomes were achieved in 40 of 51 (78%) chymopapain-treated patients and in 39 of 49 (80%) surgically treated patients. Seventy-eight percent of the chymopapain group and 79% of the surgery group ultimately returned to full military duty. Of the nine initial chymopapain failures, eight were successfully treated with surgical discectomy. There were fewer complications, 4% versus 10%, in the chymopapain group. The authors now consider chemonucleolysis as the final conservative measure prior to surgery, rather than an alternative to surgical discectomy.