Effects of chemonucleolysis demonstrated by MR imaging

Area of Science:

• Radiology
• Neurosurgery
• Orthopedics

Background:

• Herniated lumbar discs are a common cause of back pain.
• Chymopapain is an enzyme used to treat herniated discs.
• Accurate diagnostic and prognostic imaging is crucial for treatment planning.

Purpose of the Study:

• To evaluate the diagnostic and prognostic utility of magnetic resonance (MR) imaging in patients undergoing chymopapain treatment for herniated lumbar discs.
• To assess MR imaging findings before and after chymopapain administration.

Main Methods:

• 39 patients with suspected herniated lumbar discs underwent MR imaging.
• 21 treated patients were rescanned 3 months post-chymopapain injection.
• Sagittal T1 and T2 weighted spin-echo techniques were employed for all scans.

Main Results:

• Pre-treatment MRIs showed disc space narrowing (95%), extradural defects (86%), and altered signal intensities.
• Post-chymopapain, 100% of treated discs showed decreased height; signal intensity changes were observed in 91% (T1) and 86% (T2).
• Six patients were diagnosed with free disc fragments based on initial MR scans, impacting treatment decisions.

Conclusions:

• MR imaging provides valuable diagnostic information for herniated lumbar discs prior to chymopapain therapy.
• Post-treatment MR findings, including disc height reduction and signal alterations, are observable but did not correlate with clinical success in this study.
• Initial MR imaging can identify specific conditions like free disc fragments, influencing management strategies for chymopapain treatment.