Summary
Chemonucleolysis is an established non-operative treatment of a prolapsed symptomatic lumbar disc. It was introduced as a form of treatment in the early 1960s by Smith [18]. One of the main causes of failure is the difficulty in pre-operative assessment of a contained disc prolapse. Reducing failure rates is very important for the morale of surgeon and patient alike. We investigated 58 patients with magnetic resonance imaging (MRI) to select those with a contained protrusion prior to chemonucleolysis. Per-operative discography confirmed contained protrusion in 96.5% (56/58) of cases, increasing the specificity of selection. At 6 months post chemonucleolysis 86% of our patients were asymptomatic. We would commend MRI as the investigation method of choice prior to chemonucleolysis for a prolapsed symptomatic lumbar disc, thus avoiding separate diagnostic discography, thereby reducing inconvenience to the patient and wastage of prepared chymopapain.
Similar content being viewed by others
References
Bischoff RJ, Rodriguez RP, Gupta K, Righi A, Dalton JE, Whitecloud TS (1993) A comparison of computed tomography-myelography, magnetic resonance imaging, and myelography in the diagnosis of herniated nucleus pulposus and spinal stenosis. J Spinal Disord 6: 289–295
Cole HM (1989) Diagnostic and Therapeutic Technology Assessment (DATTA). JAMA 262: 953–956
Ferrández L, Usabiaga J, Ramos L et al (1992) Clinical and ultrastructural analysis of failures in chemonucleolysis. Clin Orthop 283: 74–80
Fraser RD (1982) Chymopapain for the treatment of intervertebral disc herniation. A preliminary of double-blind study. Spine 7: 608–712
Garvin PJ, Jennings RB, Stern IJ (1977) Enzymatic digestion of the nucleus pulposus: a review of experimental studies with chymopapain. Orthop Clin North Am 8: 27
Hackney DB (1992) Degenerative disk disease. Top Magn Reson Imaging 4: 12–36
Herkowitz HN (1991) Current status of percutaneous discectomy and chemoucleolysis. Orthop Clin North Am 22: 327–332
Javid MJ, Nordby EJ, Ford LT et al (1983) Safety and efficacy of chymopapain (chymodiactin) in herniated nucleus pulposus with sciatica. Results of a randomised double-blind study. JAMA 249: 2489–2494
Kim KY, Kim YT, Lee CS, Kang JS, Kim YJ (1993) Magnetic resonance imaging in the evaluation of the lumbar herniated intervertebral disc. Int Orthop 17: 241–244
Kramer J, Kainberger F, Stansziewski K, Steiner E, Imhof H (1993) Modern intervertebral disk diagnosis. Radiologe 33: 567–572
Lavignolle B, Sénégas J, Vital JM et al (1984) La chemonucléolyse. Journée de Pathologie Rachidienne, Bordeaux, Sénégas 1: 141–170
MacNab I (1973) Chemonucleolysis. Clin Neurosurg 20: 183–192
McCulloch JA (1977) Chemonucleolysis. J Bone Joint Surg [Br] 59: 45–52
McCulloch JA (1980) Chemonucleolysis. Experience with 2000 cases. Clin Orthop 146: 128–135
Menkes CJ (1986) Indications and contraindications of nucleolysis. In: Bonneville J-F (ed) Focus on chemonucleolysis. Springer, Berlin Heidelberg New York, pp 23–27
Nordby EJ, Wright PH, Schofield SR (1993) Safety of chemonucleolysis: adverse effects reported in the United States, 1982–1991. Clin Orthop 293: 122–134
Ross JS, Modic MT (1992) Current assessment of spinal degenerative disease with magnetic resonance imaging. Clin Orthop 279: 68–81
Smith L (1964) Enzyme dissolution of the nucleus pulposus in humans. JAMA 187: 137
Tash R, Strauss R, Savitz MH (1991) Preoperative and postoperative neuroradiologic evaluation of lumbar disc herniation. Mt Sinai J Med 58: 129
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gosal, H.S., Harrison, D.J. Magnetic resonance imaging before chemonucleolysis for lumbar disc prolapse. Eur Spine J 4, 206–209 (1995). https://doi.org/10.1007/BF00303411
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00303411