[Technic of chemonucleolysis]

Chemonucleolysis is technically easy to perform and free from complications. Correct positioning of the patient is the most important factor for successful puncture of the intervertebral disc. Difficulties during puncture can arise if the intervertebral space is very narrow or if the articular processes of the vertebra are hypertrophied; likewise, if this is the case with the transverse process of the fifth lumbar vertebra, or if congenital lumbosacral anomalies are present. Puncture at the level of the 5th lumbar vertebral body/sacrum can be rendered more difficult by a high iliac crest. In such cases the double-needle technique should be employed. Discography as the last examination directly before nucleolysis serves to verify vertebral disc degeneration, to control the position of the needle, and to exclude perforation of the dura. 150 nucleolyses were performed without complications. In one case only the scheduled intervention had to be discontinued because of technical difficulties during puncture.