Repeat chemonucleolysis.
A review of 33 patients in whom repeat chemonucleolysis was performed in the period between 1979 and 1983 indicates satisfactory results in 24 patients for a 73% success rate. Immediate sensitivity reactions (anaphylaxis) were seen in three patients and all were successfully managed by appropriate medical therapy. The last 12 patients were pretreated with histamine1 antagonists (hydroxyzine) and histamine2 antagonists (cimetidine). In this group there was not a single anaphylactic reaction. According to these results, repeat chemonucleolysis is a viable alternative to laminectomy and discectomy for patients suffering from recurrent lumbar disc herniations that are refractory to conservative therapy. The increased risk of sensitivity to the enzyme can be minimized by pretreatment with histamine blockers.
Sutton
J C
JC
D000293:Adolescent; D000328:Adult; D000707:Anaphylaxis / Q000209:etiology / Q000517:prevention & control*; D002917:Chymopapain / Q000009:adverse effects / Q000627:therapeutic use*; D002927:Cimetidine / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D006919:Hydroxyzine / Q000627:therapeutic use*; D007405:Intervertebral Disc Displacement / Q000188:drug therapy*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D011292:Premedication; D012008:Recurrence; D012306:Risk; D013997:Time Factors
D006634:Histamine H1 Antagonists; D006635:Histamine H2 Antagonists; D006919:Hydroxyzine; D002927:Cimetidine; D002917:Chymopapain