[Chemonucleolysis in the treatment of surgical sciatica]

Area of Science:

• Orthopedics
• Neurosurgery
• Minimally Invasive Procedures

Background:

• Sciatica due to lumbosacral disc herniation often presents treatment challenges.
• Conservative treatments like medication and physiotherapy may not always resolve persistent sciatica.
• Enzymatic disc dissolution offers a less invasive alternative to surgery.

Purpose of the Study:

• To review the mechanisms and techniques of enzymatic nucleus pulposus dissolution.
• To emphasize strict indications and exclusion criteria for this procedure.
• To analyze outcomes in a series of 150 cases and compare them with existing literature.

Main Methods:

• Percutaneous injection of a papain preparation to dissolve the nucleus pulposus.
• Review of treatment mechanisms, techniques, and patient selection criteria.
• Analysis of a personal series of 150 treated cases.

Main Results:

• Enzymatic dissolution is indicated for nerve root sciatica resistant to conservative management.
• Exclusion criteria include "excluded" disc lesions, major dysfunction, or spinal stenosis.
• The optimal candidates are young patients with subacute disc herniation.

Conclusions:

• Enzymatic disc dissolution is a viable last-resort conservative treatment for specific sciatica cases.
• This method does not preclude surgical options if it fails.
• The procedure shows comparable results to those reported in the literature.