Percutaneous treatment of lumbar disc herniation

Nine hundred and eighteen patients were subjected to percutaneous treatment of lumbar herniated disc. 733 of these were treated through enzymatic nucleolysis with chymopapain, for a total 883 levels (150 of whom were treated at two levels): 185 patients were treated with Onik's automate discectomy. Chemonucleolysis was carried out on 733 patients (79.8%) and automated discectomy in 185 cases (20.1%). Chemonucleolysis has led to the resolution of the symptoms in a high percentage of cases (82.2%). Nucleotomy was an effective method of management in 74.6% of the cases. The availability of several therapeutic methods has allowed us to respond in a more appropriate way to the patient's requirements and, in the case of failure, offer a more flexible therapeutic spectrum, and to consider surgery as the last resort. As regards the relation between enzymatic nucleolysis with chymopapain and disc nucleoaspiration, we feel that the two should not be in competition, for the indications are precise for both methods: in the enzymatic treatment, the hernia can be medium-large sized, in a sub- or extra-ligamentous position. The treatment of patients with moderately severe symptoms is preferable. In disc nucleoaspiration, the hernia must be small-sized.