Chemonucleolysis versus discectomy: a randomized multicenter trial.
A randomized clinical trial was carried out to compare the results of open discectomy with those of chemonucleolysis in 151 patients suffering from a disc herniation at L4-5 or L5-S1. All patients fulfilled strict entry criteria; 78 patients underwent open discectomy and 73 were subjected to chemonucleolysis. An increase in radicular pain immediately after treatment was encountered in 16 patients (22%) in the chemonucleolysis group, as compared to none in the discectomy group. The efficacy of discectomy appeared to be definitely superior to that of chemonucleolysis. Within a follow-up period of 1 year, 18 patients (25%) required open discectomy following failed chemonucleolysis; two patients (3%) in the discectomy group needed a second operation. Open discectomy following previous chemonucleolysis was successful in only 44% of cases. Comparison of the final results of the two modes of treatment 12 months after the last intervention (including second treatment) did not reveal any significant differences. The duration of the preoperative symptoms, the level of disc herniation, and the leakage of contrast medium out of the disc appeared to be of no relevance to the final outcome. The complication rates in both treatment groups were low.
van Alphen
H A
HA
Department of Neurosurgery, Free University Hospital, Amsterdam, The Netherlands.
Braakman
R
R
Bezemer
P D
PD
Broere
G
G
Berfelo
M W
MW
D000293:Adolescent; D000328:Adult; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D007404:Intervertebral Disc Chemolysis; D007405:Intervertebral Disc Displacement / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011897:Random Allocation