title: Chymopapain chemonucleolysis: a review of 105 cases.
abstract: A review of 105 consecutive cases of chymopapain chemonucleolysis for single level lumbar disc herniation was undertaken. Mean follow-up was 12.2 years (range 10-15.3). Patients were assessed using the Oswestry Disability Questionnaire. Eighty-seven patients were available for follow-up. An excellent or good response occurred in 58 patients (67%); four patients (4.5%) had a moderate response but were only minimally disabled. The treatment failed in 25 patients (28.5%) and 21 of these went on to surgery within a mean of 5.2 months (range 3 weeks-12 months). In 15 patients (71%) disc sequestration or lateral recess stenosis was found. Five of the remaining six cases had a large disc herniation at surgery. Surgery resulted in a significant improvement in nine cases. Discitis following chemonucleolysis occurred in six patients (5.7%). Chymopapain chemonucleolysis has a useful role in the management of lumbar intervertebral disc prolapse. However, its efficacy is dependent on careful clinical and radiological patient selection.
authors.affiliation: Department of Orthopaedic Surgery, Mater Misericordiae Hospital, Dublin, Ireland.
authors.forename: A R
authors.initials: AR
authors.lastname: Poynton
authors.forename: D A
authors.initials: DA
authors.lastname: O'Farrell
authors.forename: D
authors.initials: D
authors.lastname: Mulcahy
authors.forename: N T
authors.initials: NT
authors.lastname: Corrigan
authors.forename: F
authors.initials: F
authors.lastname: McManus
mesh_terms: D000328:Adult; D000368:Aged; D002917:Chymopapain / Q000627:therapeutic use*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007404:Intervertebral Disc Chemolysis; D007405:Intervertebral Disc Displacement / Q000188:drug therapy* / Q000601:surgery; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged