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Long-term changes in the magnetic resonance image after chemonucleolysis
W H Castro1, H Halm, J Jerosch
1Orthopädische Klinik, Westfälische Wilhelms Universität, Münster, Germany.
Abstract:
After treatment of a symptomatic herniated disc with chymopapain, 14 patients were re-examined by magnetic resonance imaging (MRI) at a mean follow-up of 72 months. Well-defined MRI findings before chemonucleolysis were compared with those after the procedure by an independent observer. Five MRI parameters were assessed. No significant change was noted in the signal intensity of the affected disc, the extent of osteochondrosis and endplate reaction of the affected segment. The height of the affected disc as well as the size of the disc herniation were reduced significantly. The loss of the height is seen as a direct result of chymopapain activity, whereas the alteration of the size of the herniation seems to depend on the natural history of a disc herniation and is probably not a simple result of the treatment.
Insights
Chymopapain treatment for herniated discs significantly reduced disc height and herniation size over 72 months. While disc height loss is attributed to treatment, herniation size changes may reflect natural healing processes.
Area of Science:
- Neurosurgery
- Radiology
- Orthopedics
Background:
- Symptomatic herniated discs are a common cause of back pain.
- Chymopapain injections were used to treat herniated discs.
- Long-term effects of chymopapain on disc morphology require further investigation.
Purpose of the Study:
- To evaluate the long-term magnetic resonance imaging (MRI) changes after chymopapain treatment for symptomatic herniated discs.
- To compare pre- and post-treatment MRI findings in patients receiving chemonucleolysis.
Main Methods:
- Retrospective analysis of 14 patients treated with chymopapain.
- Serial MRI examinations at a mean follow-up of 72 months.
- Independent assessment of five MRI parameters: signal intensity, osteochondrosis, endplate reaction, disc height, and herniation size.
Main Results:
- Significant reduction in affected disc height and herniation size observed.
- No significant changes in disc signal intensity, osteochondrosis, or endplate reaction.
- Disc height loss correlated with chymopapain treatment; herniation size changes likely influenced by natural disc history.
Conclusions:
- Chymopapain effectively reduces disc height in patients with herniated discs.
- Long-term herniation size reduction may be multifactorial, involving both treatment and natural disease progression.
- MRI provides valuable long-term follow-up data for chemonucleolysis outcomes.