Chemonucleolysis: advantages and disadvantages. 1990

L Boccanera, and M Laus
Divisione Unità Operativa di Chirurgia Vertebrale, Centro Traumatologico Ortopedico, Bologna.

The authors report their experience with 60 patients treated for lumbar disc herniation by chemonucleolysis with chymopapain and followed-up 1 to 3 years after treatment. Long-term results were as follows: excellent: 50%; good: 40%; fair: 8.2%; poor: 1.8%. The high percentage of positive results is attributed to the rigid criteria for patient selection used, which resulted in treatment by chemonucleolysis in only 18.6% of the surgical cases of lumbar disc pathology observed. 27.2% of the patients treated complained of disorders which resulted in postoperative complications and/or prolonged convalescence: prolonged low back pain and vertebral stiffness in 20%, persistent contralateral sciatic pain in 5.4%; intense but transitory worsening of the sciatica in 1.8%. The most feared complication of chemonucleolysis is paraplegia occurring after the inadverted injection of the enzyme into the spinal fluid. This risk overshadows the positive attributes of the method. The most important advantage of chemonucleolysis, as compared with surgery, is that it avoids epidural scarring and permanent postoperative anatomical changes. Patients may benefit from these advantages, but they must be willing to accept the negative aspects of the method, as well.

UI MeSH Term Description Entries
D007404 Intervertebral Disc Chemolysis The dissolving of the NUCLEUS PULPOSUS, the semi-gelatinous tissue of a displaced INTERVERTEBRAL DISC. It is usually achieved by the direct injection of a proteolytic enzyme, especially CHYMOPAPAIN, into the herniated disc. Chemolysis, Intervertebral Disk,Chemonucleolysis,Discolysis,Intervertebral Disk Chemolysis,Nucleolysis, Intervertebral Disk,Chemolysis, Intervertebral Disc,Nucleolysis, Intervertebral Disc,Chemolyses, Intervertebral Disc,Chemolyses, Intervertebral Disk,Chemonucleolyses,Discolyses,Intervertebral Disc Chemolyses,Intervertebral Disc Nucleolyses,Intervertebral Disc Nucleolysis,Intervertebral Disk Chemolyses,Intervertebral Disk Nucleolyses,Intervertebral Disk Nucleolysis,Nucleolyses, Intervertebral Disc,Nucleolyses, Intervertebral Disk
D007405 Intervertebral Disc Displacement An INTERVERTEBRAL DISC in which the NUCLEUS PULPOSUS has protruded through surrounding ANNULUS FIBROSUS. This occurs most frequently in the lower lumbar region. Disc Herniation,Disc Protrusion,Disc, Herniated,Disk Herniation,Disk Protrusion,Disk, Herniated,Intervertebral Disc Herniation,Intervertebral Disc Protrusion,Intervertebral Disk Displacement,Intervertebral Disk Herniation,Intervertebral Disk Protrusion,Prolapsed Disk,Protruded Disc,Protruded Disk,Slipped Disk,Disk Prolapse,Herniated Disc,Herniated Disk,Prolapsed Disc,Slipped Disc,Disc Displacement, Intervertebral,Disc Herniations,Disc Protrusion, Intervertebral,Disc Protrusions,Disc Protrusions, Intervertebral,Disc, Prolapsed,Disc, Protruded,Disc, Slipped,Discs, Protruded,Disk Displacement, Intervertebral,Disk Herniations,Disk Prolapses,Disk Protrusion, Intervertebral,Disk Protrusions,Disk, Prolapsed,Disk, Protruded,Disk, Slipped,Herniated Discs,Herniated Disks,Herniation, Disc,Herniation, Disk,Herniation, Intervertebral Disc,Herniation, Intervertebral Disk,Intervertebral Disc Displacements,Intervertebral Disc Herniations,Intervertebral Disc Protrusions,Intervertebral Disk Displacements,Intervertebral Disk Herniations,Intervertebral Disk Protrusions,Prolapse, Disk,Prolapsed Discs,Prolapsed Disks,Prolapses, Disk,Protruded Discs,Protruded Disks,Protrusion, Disc,Protrusion, Disk,Protrusion, Intervertebral Disc,Protrusion, Intervertebral Disk,Protrusions, Intervertebral Disk,Slipped Discs,Slipped Disks
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011859 Radiography Examination of any part of the body for diagnostic purposes by means of X-RAYS or GAMMA RAYS, recording the image on a sensitized surface (such as photographic film). Radiology, Diagnostic X-Ray,Roentgenography,X-Ray, Diagnostic,Diagnostic X-Ray,Diagnostic X-Ray Radiology,X-Ray Radiology, Diagnostic,Diagnostic X Ray,Diagnostic X Ray Radiology,Diagnostic X-Rays,Radiology, Diagnostic X Ray,X Ray Radiology, Diagnostic,X Ray, Diagnostic,X-Rays, Diagnostic
D002917 Chymopapain A cysteine endopeptidase isolated from papaya latex. Preferential cleavage at glutamic and aspartic acid residues. EC 3.4.22.6. Chemolase,Chymodiactin,Chymopapain A,Chymopapain B,Discase
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults

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