Paraplegia Following Chemonucleolysis

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Abstract
A case report of inadvertent chymopapain introduction into the lumbar theca is reported. It led to an extensive subarachnoid and subdural hemorrhage, producing paraplegia. The neurotoxicity of chymopapain in the experimental model is reviewed and related to a clinical setting. There appears to be no tolerance for this discolytic agent either in the peripheral or CNS. CSF barbotage may lessen the neurologic injury by removing the enzyme when it finds its way inadverently into the subarachnoid space.

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