Computed tomography scanning after chymopapain injection for herniated nucleus pulposus. A prospective study

Area of Science:

• Neurosurgery
• Radiology
• Minimally Invasive Procedures

Background:

• Herniated nucleus pulposus is a common cause of low back pain.
• Chymopapain injection offers a less invasive treatment option compared to surgery.
• Evaluating treatment efficacy requires objective imaging and clinical correlation.

Purpose of the Study:

• To prospectively evaluate the effect of chymopapain injection on herniated disc size using computed tomography (CT).
• To correlate early CT findings with treatment outcomes and guide clinical decision-making.

Main Methods:

• Fifty patients with herniated nucleus pulposus received chymopapain injection.
• Pre- and post-injection CT scans were obtained at three months, with some at six months.
• CT scans were interpreted blindly to assess changes in disc herniation size.

Main Results:

• Only 12% of patients showed obvious disc size changes on CT scans at three months post-injection.
• By six months, 70% of evaluated patients demonstrated significant CT changes.
• Fourteen percent of patients failed chymopapain treatment and underwent surgery, with only 30% showing early CT changes.

Conclusions:

• Chymopapain injection does not significantly alter herniated disc size within the first three months.
• Clinical outcomes, rather than three-month CT appearance, are crucial for determining chymopapain treatment failure.
• Delayed imaging may better reflect the therapeutic effects of chymopapain on disc morphology.