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Discitis following chemonucleolysis. An experimental study.

R D Fraser, O L Osti, B Vernon-Roberts

    Spine
    |September 1, 1986
    PubMed
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    Discitis after intradiscal injections is caused by infection, not chemical reactions from chymopapain. Studies show chymopapain has a bactericidal effect, while the contrast agent Conray 280 does not significantly inhibit bacterial growth.

    Area of Science:

    • Orthopedics
    • Infectious Disease
    • Biochemistry

    Background:

    • Discitis following chemonucleolysis is often misattributed to chemical reactions from chymopapain.
    • The role of infection versus chemical reaction in post-injection discitis requires clarification.

    Purpose of the Study:

    • To investigate the in vitro antibacterial effects of chymopapain and Conray 280.
    • To test the hypothesis that discitis after intradiscal chymopapain injection results from infection.

    Main Methods:

    • In vitro testing of chymopapain and Conray 280 against various bacteria.
    • Animal study involving lumbar intradiscal injections in sheep with chymopapain and Staphylococcus epidermidis.

    Main Results:

    • Chymopapain demonstrated a bactericidal effect, particularly on Gram-positive organisms; Conray 280 showed minimal antibacterial activity.

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  • Sheep injected with chymopapain and bacteria developed discitis, while controls did not.
  • Bacterial evidence was often absent in established lesions at sacrifice, suggesting infection as the primary trigger.

    • Conclusions:

    • Discitis following intradiscal injection is consistently due to infection introduced during the procedure.
    • The findings challenge the notion that chemical irritation from chymopapain is a primary cause of post-injection discitis.