EFFICACY OF CHYMOPAPAIN IN CHEMONUCLEOLYSIS - A REVIEW

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.