Cervical chemonucleolysis

Forty patients with 44 cervical disc herniations were injected with 1500 to 1800 U of chymopapain from September 1988 to March 1992. After prophylactic H1-H2 receptor antagonist administration and under neuroleptanalgesia, a needle was inserted into the disk through an anterolateral approach, guided by x-ray monitoring. The discography performed before the enzyme injection confirmed the herniation in every case. The diagnosis was established by radiculography, computerized tomography (CT) scan, radiculo-CT scan, magnetic resonance imaging (MRI), or discography. Average follow up was 21.4 months (range: 3 to 43). Overall, there were 34 (85%) satisfactory results, 3 fair (7.5%), and 3 poor (7.5%) results. There were no complications, and the average hospital stay was 26 hours. Post-injection MRI performed in 18 cases confirmed the complete disappearance of the herniation in 13 cases. These data support the efficacy and innocuity of chymopapain chemonucleolysis in managing soft cervical disk herniations.