[Surgery in failure of nucleolysis of lumbar disk hernia]

The authors have reviewed 206 cases of sciatica treated by Chemonucleolysis. Thirty-two had to be operated on later. This treatment was more frequently needed at L4/L5 level than at the lumbosacral level. Most of the failures of Chemonucleolysis were related to lateral spinal stenosis (13 cases). In 4 cases it was due to disc extrusion either at the time of the Chemonucleolysis (2 cases) or appearing later (2 cases). Nine failures were due to subligamentous disc herniation. Two cases were operated on for the onset of sciatica at another level, repeated treatment with Chemonucleolysis being contra-indicated. In 3 cases, the surgical exploration did not discover the cause of the sciatica. The surgical cases were not impeded by the preceding Chemonucleolysis and no adhesions were found. The results were similar to those observed after primary surgery - about two-thirds of satisfactory results. They were better when a herniation at another level was found or in cases of disc extrusion than in cases of spinal cord stenosis or sub-ligamentous herniae. They were poor when the cause of the sciatica was not found.