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Intraoperative chemonucleolysis as an adjunct to lumbar discectomy
O Sagher1, T A Szabo, A G Chenelle
1Section of Neurosurgery, University of Michigan Medical Center, USA.
Study Design:
This is a report of a series of 104 patients who underwent lumbar discectomy and chemonucleolysis at the University of Virginia between 1985 and 1989.
Objective:
The primary objective was to determine the safety of this procedure. A secondary objective was to begin studying its efficacy.
Summary Of Background Data:
This is the first report on the use of chymopapain during open surgery.
Methods:
Patients with low back pain and radicular symptoms not cured with conservative therapy were selected for participation in the study. Intraoperatively, disc spaces were injected with 2 ml of chymopapain. Patients were followed-up for an average of 5 years. Patients were surveyed regarding pain relief, and failures of the procedure were analyzed.
Results:
Seventy percent of patients reported good or excellent pain relief. Operative failures, characterized by reoperation at the same level, totaled 9.6%. Recurrent disc herniation at the time of reoperation occurred in 4.8%.
Conclusion:
The procedure is safe and the relief of pain was similar to that in other published series. The suggestion is that the rate of recurrent disc herniation is reduced.