title: Five-year results from chemonucleolysis with chymopapain or collagenase: a prospective randomized study.
abstract: METHODS
  A 5-year clinical follow-up assessment of a prospective randomized study of chemonucleolysis using chymopapain (4000 IU) or collagenase (400 ABC units) was performed.
  
  
  BACKGROUND
  Intradiscal therapy can be performed for patients with contained discs by chemonucleolysis, percutaneous discectomy, or laser ablation. The oldest intradiscal therapy is chemonucleolysis with chymopapain.
  
  
  OBJECTIVE
  The purpose of this study was to compare prospectively the efficacy of chymopapain and collagenase for intradiscal injection.
  
  
  METHODS
  In this study, 100 patients with indication for intradiscal therapy were prospectively randomized to treatment with either chymopapain or collagenase. All the injections were performed by the double-needle technique with the patient under general anesthesia. The mean age of the patients was 35.5 years in the chymopapain group and 38 years in the collagenase group. An equal number of injections was performed at L4-L5 and L5-S1.
  
  
  RESULTS
  After 5 years, good and excellent results were observed in 72% of the chymopapain group and 52% of the collagenase group when the surgically treated and lost patients were graded as poor. Using a scale of 0 (no pain) to 10 (intractable pain), the pain level dropped from 8.5 to 0.7 in the chymopapain group and from 8.6 to 0.9 in the collagenase group. Microdiscectomy at the injected level was required for 23 patients (14 in the collagenase group and 9 in the chymopapain group).
  
  
  CONCLUSIONS
  After 5 years, no deterioration had occurred, as compared with the 1-year follow-up assessment. Chymopapain has proved to be safe, with one minor anaphylactic reaction, and effective even over the long term. Collagenase may need further study and cannot be recommended at this time.
authors.affiliation: Department of Orthopaedic Surgery, St. Elisabeth-Hospital, Herten, Germany. ralf.wittenberg@ruhr-uni-bochum.de
authors.forename: R H
authors.initials: RH
authors.lastname: Wittenberg
authors.forename: S
authors.initials: S
authors.lastname: Oppel
authors.forename: F A
authors.initials: FA
authors.lastname: Rubenthaler
authors.forename: R
authors.initials: R
authors.lastname: Steffen
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000139:chemically induced; D002917:Chymopapain / Q000009:adverse effects / Q000627:therapeutic use*; D017364:Collagenases / Q000627:therapeutic use*; D017586:Diskectomy; D005260:Female; D006801:Humans; D007404:Intervertebral Disc Chemolysis / Q000379:methods*; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery / Q000628:therapy*; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D011897:Random Allocation; D016896:Treatment Outcome
chemical_list: D002917:Chymopapain; D017364:Collagenases