Treatment of Lumbar Disc Herniation by Chymopapain Chemonucleolysis

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Abstract
Of 120 patients with herniated lumbar discs who received an intradiscal injection of chymopapain, 90 achieved successful recovery. Of the 21 patients who underwent subsequent surgery, 16 had a good result. Study of the unsuccessful cases showed that disc sequestration and lateral stenosis were the major organic causes of failure. Certain radiologic criteria suggestive of sequestration and of important segmental stenosis are described. They appear to be a contraindication to chemonucleolysis. Psychogenic pain components and the failure of the enzyme to hydrolyze the nuclear proteoglycans in a few cases were the other 2 causes of poor results. A survey of postchemonucleolysis computed tomographic scans suggested that, although capable of digesting nuclear material in most cases, chymopapain may also work through an antiinflammatory mechanism.

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