[Clinical experience with intradisk chymopapain administration in lumbar intervertebral disk displacement]

In a retrospective study, complications following 157 chemonucleolyses (CNL) with chymopapain in 139 patients wer studied and the kind of pathological changes as found in the operation after CNL compared with those found in patients who were operated on because free sequesters were suspected on discography. The indications for CNL followed the accepted criterion of clinically, neuroradiologically or electromyographically detected alteration of a lumbar nerve root with clinical signs of sciatica. Free sequesters were found at subsequent operation much more often in those cases with primary indications for CNL, which showed signs of sequestration at discography, than in those who had had poor results after CNL. Discography as a means of finding previously undetected free sequesters should not be abandoned. In addition to procedure-related reactions and unspecific complications, as well as immediate or delayed occurrence of severe backache, significant leucocytosis was observed on the first postoperative day. Probably immunological reactions such as severe hypotension after several hours, nausea and vomiting or rise of temperature, also occurred. In ten cases delayed urticarial or large erythematous efflorescences were observed. These reactions do obviously not correspond to the picture of anaphylaxis of the reagine-type such as is mostly described in the mechanism of chymopapain allergy.