Mj. Javid, CHEMONUCLEOLYSIS VERSUS LAMINECTOMY - A COHORT COMPARISON OF EFFECTIVENESS AND CHARGES, Spine (Philadelphia, Pa. 1976), 20(18), 1995, pp. 2016-2022
Study Design. A prospective cohort study was done comparing 100 consec
utive chemonucleolysis patients with 100 consecutive laminectomy patie
nts. Objectives. The effectiveness and cost of chymopapain chemonucleo
lysis was compared with that of laminectomy to manage herniated lumbar
discs. Summary of Background Data, Although the efficacy of chemonucl
eolysis has been established, controversy regarding the relative benef
its of chemonucleolysis and laminectomy continues to arise. The relati
ve cost-effectiveness of the two procedures has not been evaluated pre
viously in a cohort study. Methods, Patients in both treatment groups
were of comparable age, height and weight, and worker's compensation s
tatus. Patients with migrated disc were not considered for chemonucleo
lysis. Improvement in pain, paresthesia, straight-leg raising, reflexe
s, motor loss, and sensory function, self-reported overall improvement
, ability to maintain employment, and charge of treatment were used to
measure treatment success. Results. Clinical assessment after 6 weeks
showed 92% of laminectomy patients compared with 82% of chemonucleoly
sis patients had successful results (P = 0.058). Chemonucleolysis pati
ents had greater improvement in numbness (P = 0.014) and sensory and m
otor functions (P = 0.002). After 6 months, 88% of chemonucleolysis pa
tients and 85% of laminectomy patients had successful results, with a
greater improvement in sensory status of chemonucleolysis patients (P
< 0.001). After 1 year, 87% of chemonucleolysis patients and 82% of la
minectomy patients had successful results, and more chemonucleolysis p
atients than laminectomy patients were employed. Based on similar ther
apeutic results, the average charge savings for chemonucleolysis patie
nts was $5365 when chemonucleolysis was performed instead of laminecto
my. Conclusion. This study shows that chemonucleolysis is as effective
as laminectomy in appropriately selected patients but at lower charge
and can contribute substantially to reducing short- and long-term hea
lth costs.