Chemonucleolysis in the treatment of lumbar disc disease.
Occupational safety and health symposia 1977. Cincinnati, OH: U.S. Department of Health, Education, and Welfare, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, DHEW (NIOSH) Publication No. 78-169, 1978 Jun; :95-99
The use of chemonucleolysis in the treatment of discogenic pain associated with lumbar disc disease was described. The anatomy and physiology of the intervertebral disc were reviewed in reference to changes occurring with age that contribute to degenerative disc disease. Chemonucleolysis involved the injection of therapeutic doses of chymopapain into the intervertebral disc space to induce depolymerization of mucoprotein. The indications for chemonucleolysis were comparable to those for laminectomy and included those patients in which laminectomy failed and those patients indicated for repeat laminectomies. Contraindications to chemonucleolysis included neurologic deficits, spinal stenosis, arachnoiditis, pregnancy, and previous chemonucleolysis. Preoperative evaluation included electromyography to confirm the presence of a herniated disc, myelography to discount spinal stenosis and spinal cord tumor, epidural venography, and prognostic psychometric testing. The technique, postoperative treatment, and complications of the chemonucleolytic procedure were described.
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