INTRAOPERATIVE CHEMONUCLEOLYSIS AS AN ADJUNCT TO LUMBAR DISKECTOMY

Study Design. This is a report of a series of 104 patients who underwe nt lumbar discectomy and chemonucleolysis at the University of Virgini a between 1985 and 1989. Objective. The primary objective was to deter mine the safety of this procedure. A secondary objective was to begin studying its efficacy. Summary of Background Data. This is the first r eport 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. Intraoperativel y, disc spaces were injected with 2 ml of chymopapain. Patients were f ollowed-up for an average of 5 years. Patients were surveyed regarding pain relief, and failures of the procedure were analyzed. Results. Se venty percent of patients reported good or excellent pain relief. Oper ative failures, characterized by reoperation at the same level, totale d 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.