Post-chymopapain (chemonucleolysis)--clinical and computed tomography correlation: preliminary results

Area of Science:

• Neurosurgery
• Minimally Invasive Procedures
• Biologics

Background:

• Chymopapain, an enzyme, has been used for lumbar disc herniation treatment in Canada and Europe since 1964.
• Its mechanism, decreasing intradiscal pressure and disc volume, lacks substantial in vivo evidence.
• Recently approved in the US, its efficacy requires further in vivo validation.

Purpose of the Study:

• To investigate the in vivo effects of chemonucleolysis on lumbar disc herniation.
• To correlate imaging findings with clinical outcomes following chymopapain injection.

Main Methods:

• 17 patients with lumbar disc herniation underwent chemonucleolysis.
• High-resolution computed tomography (CT) scans were used for pre- and post-treatment imaging.
• Clinical outcomes were assessed in relation to imaging changes.

Main Results:

• Disc space narrowing was observed in nearly all patients post-treatment.
• Retraction of prolapsed or extruded discs occurred in a significant number of patients.
• Clinical improvement strongly correlated with disc retraction.

Conclusions:

• Chemonucleolysis with chymopapain demonstrates in vivo efficacy in reducing disc herniation.
• Disc retraction is a key factor in achieving clinical improvement.
• Optimal results are achieved with single-level injections in cases of clearly demonstrable disc prolapse.