Treatment of herniated lumbar disk syndrome with chymopapain

One hundred twenty-four patients with herniated lumbar disks received intradiskal injections of chymopapain before the Food and Drug Administration's withdrawal of the drug. One year after injection, 90 patients (72.6%) experienced major improvement, 21 (16.9%) had slight improvement, and 13 (10.5%) had no improvement. Of those patients who had no previous back surgery and who were not compensation cases, 77 patients (81%) had marked improvement, 13 (13.7%) had slight improvement, and five (5.3%) had no improvement. Three- to six-year follow-ups were obtained by questionnaire. Of the 114 patients responding, overall 83 patients (72.8%) had marked improvement, and 75 (83.3%) of those with no previous surgery and who were not workmen's compensation cases had major improvement. Since all patients met objective criteria for diskectomy, favorable results from chemonucleolysis spared most the trauma of surgery and its attendant convalescence. These results indicate that chemonucleolysis can and should be considered an advantageous alternative to surgery in appropriately selected patients.