Complications following chemonucleolysis with collagenase

Area of Science:

• Spinal Surgery
• Biomaterials Science
• Histopathology

Background:

• Chemonucleolysis is a minimally invasive procedure for treating lumbar disc herniation.
• Collagenase is an enzyme used in chemonucleolysis to break down disc tissue.
• Understanding the histological effects of chemonucleolysis is crucial for patient outcomes.

Purpose of the Study:

• To compare the histological effects of chemonucleolysis with collagenase to natural disc degeneration.
• To evaluate the impact of chemonucleolysis on the nucleus pulposus, anulus fibrosus, and surrounding spinal structures.

Main Methods:

• Light and scanning electron microscopy (SEM) were used to examine lumbar disc tissue.
• Tissue samples were obtained from patients who underwent unsuccessful chemonucleolysis (n=8) and primary disc surgery (control, n=8).

Main Results:

• Control discs showed collagen degeneration, microcysts, and giant chondromas, but intact anulus fibrosus and end-plates.
• Chemonucleolysis resulted in digestion of the nucleus pulposus and anulus fibrosus.
• Extensive damage to end-plates, bone, ligaments, and epidural fat was observed after chemonucleolysis.

Conclusions:

• Chemonucleolysis with collagenase causes severe histological damage beyond the nucleus pulposus.
• The procedure's effects differ significantly from natural disc degeneration, impacting structural integrity.
• Further research is needed to refine chemonucleolysis techniques and minimize adverse effects.