CHEMONUCLEOLYSIS VERSUS LAMINECTOMY - A COHORT COMPARISON OF EFFECTIVENESS AND CHARGES

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.