The long-term results of chymopapain chemonucleolysis for lumbar disc disease

Abstract

✓ The long-term clinical outcome is evaluated for 268 patients after chymopapain chemonucleolysis for radicular complaints referrable to documented intervertebral disc disease. The follow-up period for 92% of these patients was 10 years. No complications due to chymopapain toxicity were observed; 80.1% of patients were relieved of their presenting radicular leg pain and 75.1% were employed at a capacity equal to or more strenuous than before injection. Chemonucleolysis was demonstrated to be a safe and effective treatment modality, with long-term results that compare favorably with those of similarly selected patients undergoing open surgical procedures. In the patients whose chymopapain therapy failed, the outcome of subsequent open surgical procedures was not necessarily compromised by prior chemonucleolysis. A higher rate of failure and subsequent surgical intervention was seen in those patients with injections performed soon after an unsuccessful open procedure on the same side and at the same interspace, those with workmen's compensation or litigation pending, those with a history of work-related injury, those whose employment involved heavy manual labor or extensive driving, and those whose preinjection spine x-ray films indicated retrograde spondylolisthesis.