Magnetic resonance imaging before chemonucleolysis for lumbar disc prolapse

Area of Science:

• Neurosurgery
• Radiology
• Orthopedics

Background:

• Chemonucleolysis is a recognized non-operative treatment for symptomatic lumbar disc prolapse.
• Pre-operative assessment challenges, particularly identifying contained disc prolapse, contribute to treatment failures.
• Minimizing failure rates is crucial for both surgical and patient confidence.

Purpose of the Study:

• To evaluate the efficacy of magnetic resonance imaging (MRI) in selecting patients with contained lumbar disc protrusions for chemonucleolysis.
• To assess the impact of MRI-guided selection on chemonucleolysis success rates and diagnostic accuracy.

Main Methods:

• Retrospective analysis of 58 patients undergoing chemonucleolysis for symptomatic lumbar disc prolapse.
• Pre-operative assessment utilized magnetic resonance imaging (MRI) to identify contained disc protrusions.
• Intra-operative discography was performed to confirm the presence of contained protrusion.

Main Results:

• Magnetic resonance imaging (MRI) successfully identified contained protrusions in patients selected for chemonucleolysis.
• Per-operative discography confirmed contained protrusion in 96.5% (56/58) of cases, validating MRI's specificity.
• At 6 months post-chemonucleolysis, 86% of patients reported being asymptomatic.

Conclusions:

• Magnetic resonance imaging (MRI) is recommended as the preferred pre-operative investigation for symptomatic lumbar disc prolapse prior to chemonucleolysis.
• Utilizing MRI enhances diagnostic specificity, potentially avoiding separate diagnostic discography.
• This approach reduces patient inconvenience and conserves valuable therapeutic agents like chymopapain.