Chymopapain chemonucleolysis: a review of 105 cases

A review of 105 consecutive cases of chymopapain chemonucleolysis for singl e level lumbar disc herniation was undertaken. Mean follow-up was 12.2 year s (range 10-15.3). Patients were assessed using the Oswestry Disability Que stionnaire. Eighty-seven patients were available for follow-up. An excellen t or good response occurred in 58 patients (67%); four patients (4.5%) had a moderate response but were only minimally disabled. The treatment failed in 25 patients (28.5%) and 21 of these went on to surgery within a mean of 5.2 months (range 3 weeks-12 months). In 15 patients (71%) disc sequestrati on or lateral recess stenosis was found. Five of the remaining sh cases had a large disc herniation at surgery. Surgery resulted in a significant impr ovement in nine cases. Discitis following chemonucleolysis occurred in sis patients (5.7%). Chymopapain chemonucleolysis has a useful role in the mana gement of lumbar intervertebral disc prolapse. However, its efficacy is dep endent on careful clinical and radiological patient selection.