Chemonucleolysis in lumbar disc herniation: a meta-analysis.
OBJECTIVE
To carry out a systematic review and meta-analysis of the efficacy of chemonucleolysis in the treatment of lumbar disc herniation.


METHODS
Clinical trials were selected from 3 electronic databases (The Cochrane Controlled Trials Register, MEDLINE, and EMBASE). Data were analyzed with the software STATA, using the meta command.


RESULTS
Twenty-two clinical trials were eligible. For chemonucleolysis versus placebo, the summary risk ratio estimate for pain relief as outcome was 1.51 (95% CI: 1.27-1.80). The summary estimate was 1.07 (95% CI: 0.95-1.20) for the comparison between chymopapain and collagenase. Regarding chemonucleolysis with chymopapain versus surgery, the fixed-effect summary estimate of effect for pain relief was 0.93 (95% CI: 0.88-0.98) with surgery as the reference group. In this case, heterogeneity was statistically significant.


CONCLUSIONS
Chemonucleolysis with chymopapain was superior to placebo and was as effective as collagenase in the treatment of lumbar disc prolapse. Results for studies comparing chemonucleolysis with surgery were heterogeneous, making it difficult to interpret the summary measure of effect.
Couto
José Mauro Cardoso
JM
Department of Preventive Medicine, Medical School, São Paulo University, São Paulo, SP, Brazil.
Castilho
Euclides Ayres de
EA
Menezes
Paulo Rossi
PR
D002917:Chymopapain / Q000627:therapeutic use*; D017364:Collagenases / Q000627:therapeutic use*; D018849:Controlled Clinical Trials as Topic / Q000592:standards; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D007404:Intervertebral Disc Chemolysis / Q000592:standards*; D007405:Intervertebral Disc Displacement / Q000188:drug therapy*; D010919:Placebos / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
D010919:Placebos; D002917:Chymopapain; D017364:Collagenases