SPINE UPDATE CHEMONUCLEOLYSIS

Even with a history of controversy and troubling complications, chymop apain has endured the test of time to show 30 years of clinical succes s in the treatment of herniated nucleus pulposus. Strict attention to indications, contraindications, and technique ensures safety and effic acy of treatment. A trend to decreased dosage may result in less posti njection spasm. Between 1982-1991, 121 adverse events in 135,000 patie nts were reported to the Food and Drug Administration and investigated , Seven cases of fatal anaphylaxis, 24 infections, 32 bleeding problem s, 32 neurologic events, and 15 miscellaneous occurrences were found. Overall mortality rate was 0.019%. All categories were of lesser incid ence than complications with laminectomy. Long-term results show that improvement after chemonucleolysis is maintained, whereas the outcome after laminectomy is reported to deteriorate with time. Cost savings w ith chemonucleolysis over laminectomy are largely a matter of shorter hospitalization. A protocol for cervical chemonucleolysis is being dev eloped in the United States after good results have been shown in Spai n and France. Other enzymes continue under investigation, but chymopap ain remains the standard to which they are compared.