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Evaluation and treatment of chemonucleolysis failures
J K Burkus1, A H Alexander, J B Mitchell
1Department of Orthopedic Surgery, Naval Hospital, Oakland, California.
Orthopedics
|December 1, 1988
Summary
Chymopapain injections for lumbar disc herniations can fail, with 16% of patients experiencing persistent sciatica. Repeat imaging confirmed nerve root compromise, necessitating open diskectomy for symptom relief.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Pain Management
Background:
- Lumbar disc herniations unresponsive to conservative therapy often require advanced treatments.
- Chemonucleolysis using chymopapain has been utilized for such conditions.
Purpose of the Study:
- To evaluate the clinical outcomes and neuroradiographic findings in patients experiencing treatment failure after chymopapain chemonucleolysis for lumbar disc herniations.
Main Methods:
- Fifty patients with lumbar disc herniations underwent chemonucleolysis with chymopapain.
- Eight patients with persistent or transient radicular symptoms were reevaluated with clinical assessment and repeat neuroradiographic studies (CT, myelography).
- These eight patients subsequently underwent open diskectomy.
Main Results:
- Sixteen percent (8/50) of patients experienced no relief or only transient improvement in sciatica following chymopapain injection.
- Repeat imaging in these eight patients demonstrated persistent nerve root compromise at the injected disc level.
- Open diskectomy resulted in complete resolution of radicular symptoms in seven patients and intermittent pain in one.
Conclusions:
- Chymopapain chemonucleolysis can be associated with treatment failure in lumbar disc herniations, often due to persistent nerve root compromise.
- Persistent radicular symptoms post-chymopapain warrant further investigation, including repeat imaging.
- Open diskectomy is an effective salvage procedure for patients with persistent symptoms after failed chemonucleolysis.