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Severe local tissue lesions after chemonucleolysis with collagenase
Surgical Neurology
|August 1, 1984
Summary
Chemonucleolysis using collagenase can cause severe tissue damage in the spine, including bone and dura mater. This case highlights potential risks associated with the procedure, necessitating careful patient selection and monitoring.
Area of Science:
- Spinal Surgery
- Interventional Radiology
- Orthopedic Surgery
Background:
- Chemonucleolysis is a minimally invasive procedure for treating lumbar disc herniation.
- Collagenase is an enzyme used to break down the nucleus pulposus.
- Complications, though rare, can occur and require thorough investigation.
Observation:
- A young female patient underwent L4-5 chemonucleolysis with collagenase.
- Post-procedure functional motor deterioration necessitated a laminectomy.
- Surgical findings revealed extensive tissue damage.
Findings:
- Severe lesions affected the cartilaginous end-plate and vertebral bone.
- Damage extended to the posterior intervertebral ligament, epidural fat, and dura mater.
- Histopathological analysis confirmed enzymatic-induced tissue injury.
Implications:
- This case underscores the potential for severe iatrogenic injury from collagenase chemonucleolysis.
- Highlights the importance of meticulous surgical technique and patient selection.
- Suggests a need for further research into the safety profile and risk mitigation strategies for enzyme-based disc treatments.