Chemonucleolysis: a note of caution

Following the approval in 1982 by the Federal Food and Drug Administration of chymopapain for public use by the medical profession in the treatment of ruptured lumbar intervertebral disk disease, chemonucleolysis has become widespread in the United States; a considerable experience has been obtained in the past 3 years, allowing for an appropriate examination of the original claims for the procedure. Chemonucleolysis is not as efficacious as surgery for simple ruptured lumbar intervertebral disk disease. Whereas the complication rates of chemonucleolysis are probably no greater than that for surgery, the incidence of unpreventable anaphylaxis and other untoward reactions makes it certainly no more safe. There is no biological basis for the belief that chemonucleolysis will result in a shorter convalescence than surgery, and it appears that chemonucleolysis has significantly increased the cost of invasive treatment of patients with ruptured lumbar intervertebral disk disease.