title: [Variation in chemonucleolysis as treatment in herniated intervertebral disk].
abstract: OBJECTIVE
  To measure the variation of chemonucleolysis in the management of lumbosacral intervertebral disk herniation in the Netherlands.
  
  
  METHODS
  Descriptive.
  
  
  METHODS
  Academic Medical Centre, Amsterdam, the Netherlands.
  
  
  METHODS
  The use of chymopapain per specialist from 1987 to 1995 was determined by dividing the amount of chymopapain sold, as given by the pharmaceutical company, by the number of specialists as recorded by the specialist associations. Subsequently, variation of chemonucleolysis in time, between specialists and in place was calculated.
  
  
  RESULTS
  Between 1987 and 1995 the number of chemonucleolysis treatments decreased gradually from 2084 to 538. Most neurosurgeons, orthopaedic surgeons and neurologists did not treat patients with herniation of a lumbosacral intervertebral disk with chemonucleolysis. Within the group of specialists which did treat patients with chemonucleolysis, a minority accounted for the majority of treatments. Chemonucleolysis was mainly performed in non-academic hospitals outside urban western Holland.
  
  
  CONCLUSIONS
  Variation of chemonucleolysis in the management of lumbosacral intervertebral disk herniation in the Netherlands is considerable. Different preferences of specialists are probably the underlying cause.
authors.affiliation: Academisch Medisch Centrum, afd. Neurologie, Amsterdam.
authors.forename: I N
authors.initials: IN
authors.lastname: van Schaik
authors.forename: H
authors.initials: H
authors.lastname: van Crevel
mesh_terms: D006801:Humans; D007404:Intervertebral Disc Chemolysis / Q000706:statistics & numerical data*; D007405:Intervertebral Disc Displacement / Q000628:therapy*; D008511:Medicine; D009426:Netherlands; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D013038:Specialization; D013997:Time Factors