Septic complications of chemonucleolysis

Area of Science:

• Spinal Surgery
• Infectious Disease

Background:

• Chemonucleolysis is a minimally invasive procedure for treating lumbar disc herniation.
• Chymopapain, an enzyme derived from papaya latex, is used to break down the nucleus pulposus.
• Septic complications are a known, albeit rare, risk associated with invasive spinal procedures.

Observation:

• Two distinct cases of severe septic complications following chemonucleolysis with chymopapain are reported.
• The first case involved a patient who developed overt aortic valve failure.
• The second case presented with an epidural abscess.

Findings:

• The cases demonstrate a potential link between chymopapain chemonucleolysis and serious infectious sequelae.
• Septic complications can manifest systemically (aortic valve) or locally (epidural space).
• Prompt recognition and management are crucial for these adverse events.

Implications:

• These findings underscore the importance of considering infectious etiologies in patients with new-onset symptoms post-chemonucleolysis.
• Further research may be warranted to elucidate the mechanisms and risk factors for these complications.
• Clinicians should maintain a high index of suspicion for infection after chymopapain treatment.