Surgery versus chemonucleolysis for herniated lumbar discs. A prospective study with random assignment.
The results of removal of a disc hernia at the L4/L5 level were compared with those obtained by the injection of 4000 IU (2 ml) of chymopapain (Discase) in 29 consecutive patients randomly selected for either treatment. All exhibited severe incapacitating sciatica, and all had a myelogram demonstrating a definite disc hernia. The two groups of patients did not differ significantly with regard to age, sex, or length of history. The total time of general anesthesia was significantly shorter for the injected patients by 20 minutes (p less than 0.01), as was the length of hospitalization, by three days (p less than 0.05). Within five months, eight of the patients receiving chymopapain injections had to be operated on because of unrelieved symptoms. All had definite disc herniae, and in four, a free fragment was found. All patients were seen at the time of dismissal from the hospital and at six and 12 months after operation by an independent observer. Comparisons made at these intervals, following either surgery or chymopapain injection with or without subsequent surgery, did not reveal any significant differences, but the short-term results following either treatment alone significantly (p less than 0.01) favored the surgical approach.
D000328:Adult; D002917:Chymopapain / Q000008:administration & dosage*; D010450:Endopeptidases / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections / Q000379:methods; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011897:Random Allocation
D010450:Endopeptidases; D002917:Chymopapain