The long-term results of chymopapain. Ten-year follow-up of 268 patients after chemonucleolysis.
The effect of chymopapain injection was investigated in myelographically confirmed intervertebral disc herniation in 268 patients after ten years. Mean age is 39.4 years, 178 males and 90 females. Sixty-two patients had compensation or litigation and 12 had prior lumbar spine surgery. Discography was performed in 223 patients, resulting in 134 one-level injections, 124 two-level injections, and ten three-level injections. Forty percent of the patients experienced postoperative muscle spasm for several days. No complications were seen in 241 patients (92%) who were available for follow-up examination at ten years; 86% had less leg pain, 82% were employed at a capacity equal to or greater than before injection, 9% were at a less strenuous job, 1% were disabled, and 8% had retired. In 22 patients treated surgically within one year of chemonucleolysis, disc-related pathology was present in 14 cases and spondylosis or spinal stenosis was present in seven cases. One had a negative exploration and continued to be disabled. Eight patients came to surgical intervention after one year because of persisting symptoms: four patients had disc protrusion, three had laminectomy and spinal fusion, and one had a decompressive laminectomy secondary to spondylotic change. Chemonucleolysis did not prejudice the outcome of subsequent surgical treatment with good results following this intervention. One tumor, a neurofibroma, was found in this study. Chemonucleolysis with chymopapain was a safe and effective treatment of radicular complaints caused by well-documented intervertebral disc herniation.
R J
RJ
Maciunas
B M
BM
Onofrio
D000328:Adult; D002917:Chymopapain / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D007796:Laminectomy; D008159:Lumbar Vertebrae; D008297:Male; D009192:Myelography; D009790:Occupations; D010808:Physical Examination; D013997:Time Factors
D002917:Chymopapain