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Chemonucleolysis for sciatica. A critical review.

A L Nachemson1, B Rydevik

  • 1Department of Orthopedics, University of Gothenburg, Sahlgren Hospital, Sweden.

Acta Orthopaedica Scandinavica
|February 1, 1988
PubMed
Summary
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Chymopapain injections for sciatica due to disc herniation are debated. Surgical disc removal is the preferred treatment for persistent sciatica after conservative care fails.

Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Pain Management

Background:

  • Chymopapain injections have been used for sciatica from disc herniation for over 25 years.
  • The efficacy and safety of chymopapain remain subjects of ongoing discussion.

Purpose of the Study:

  • To review the indications, complications, and clinical outcomes of chymopapain injections.
  • To discuss the tissue effects associated with chymopapain treatment.
  • To compare chymopapain injection outcomes with surgical disc removal.

Main Methods:

  • Literature review of studies on chymopapain for disc herniation and sciatica.
  • Analysis of clinical results and complications.
  • Discussion of chymopapain's tissue effects.

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Main Results:

  • Surgical disc removal via laminotomy is the established treatment of choice for sciatica.
  • This is indicated for patients with confirmed disc herniation unresponsive to conservative therapies.
  • Chymopapain's role remains under debate despite its long-term use.

Conclusions:

  • Surgical intervention is the documented gold standard for managing debilitating sciatica from disc herniation.
  • Conservative treatment failure necessitates consideration of surgical disc removal.
  • Chymopapain's debated status warrants careful patient selection and consideration of alternatives.