CHEMONUCLEOLYSIS IN INTERVERTEBRAL-DISK HERNIATION WITH LOW-BACK-PAINAS THE ONLY SYMPTOM - A REVIEW OF 20 CASES

Disk herniation can manifest as isolated low back pain, which is usual ly intermittent and accompanied with stiffness of the lumbar spine. Th ere is almost general agreement that neither neurosurgical treatment n or chemonucleolysis is appropriate in patients with this clinical patt ern. We used chemonucleolysis in 19 patients with recurrent episodes o f isolated low back pain and one patient with severe permanent isolate d low back pain dating back to a conservatively-treated episode of sci atica. All 20 patients had disk herniation documented by imaging studi es. A very good or satisfactory outcome was recorded in ten patients a fter three months, 11 after six months and 12 in March 1993 after a me an follow-up of 72 months. The treatment was well tolerated, even in t hose patients who were not improved; a single patient developed an epi sode of acute low back pain that required surgical treatment. In patie nts with low back pain and disk herniation, there is currently no mean s of determining whether a causal relationship links these two abnorma lities. Nevertheless, we believe that chemonucleolysis can be proposed in severe forms, provided the patients are apprised of current succes s rates.