[20 years of lumbar chymonucleolysis]

If correct indications and rigorous technique are applied, nucleolysis with chymopapain can be an effective cure for herniated nucleus pulposus in patients who do not respond to adequate medical treatment. Pain relief is obtained in approximately 75% of the patients. In case of failure, secondary surgery may be proposed with a success rate similar to primary surgery. The risk of complications is lower than for surgery. Initial satisfactory results are usually maintained at long term. The main inconveniences include a possible painful reaction in 30-40% of the patients and in certain cases progressives rather than rapid pain relief. Cost analysis shows a 40% gain over surgery. After 20 years of experience, chemonucleolysis for herniated nucleus pulposus has been shown to be an effective therapeutic technique which should be part of an overall management strategy including medical treatment and surgery.