Study Design. This study was designed to determine the current experie
nce in the use of chymopapain injection in the treatment of herniated
intervertebral discs by analyzing reports appearing between 1985 and 1
993. Forty-five clinical studies included 7,335 patients treated world
wide, some including comparisons to open laminectomy/discetomy and oth
ers to percutaneous discectomy. Objectives. Because controversy persis
ts after 30 years of clinical use of chymopapain, the results of curre
nt experience should establish the efficacy for those who want to cons
ider chemonucleolysis as a treatment for a herniated nucleus pulposus.
Summary of Background Data. There is the suggestion that use of other
than conservative treatment is made only to achieve a better result i
n the short term. The selection of type of treatment will depend on co
ntraindications, with failures of chemonucleolysis found largely in th
ose having spinal stenosis or sequestrated discs. Worker compensation
patients respond less successfully than those with better motivation.
Methods. The 45 studies were analyzed for determination of successful
outcome and divided into 16 with more than 100 patients, 13 with less
than 100 patients and 16 with comparison to other treatments. Results.
Individual success rates exceeded 60% whereas cohort total averaged 7
6%. In studies comparing chemonucleolysis with open discectomy, succes
s rate averaged 76.2% as compared with 88% for open surgery. In two ot
her studies, percutaneous discectomy was less successful than chemonuc
leolysis. Where included, duration of hospitalization showed less time
and thus less costs for chemonucleolysis. Return to work compilations
showed time off slightly less for chemonucleolysis than for laminecto
my. Conclusions. Chemonucleolysis, though somewhat less effective than
open discectomy, can be successfully and safely used in about four of
five carefully selected patients without the trauma, risks, and subse
quent fibrosis associated with lumbar disc surgery.