Treatment of protruded lumbar intervertebral discs with chymopapain (Discase)

1973 ◽  
Vol 39 (2) ◽  
pp. 203-208 ◽  
Author(s):  
Dwight Parkinson ◽  
Christopher Shields
Keyword(s):  
Intervertebral Disc ◽  
Drug Administration ◽  
Food And Drug Administration ◽  
Intervertebral Discs ◽  
Intervertebral Disc Disease ◽  
Disc Disease ◽  
Chemical Action ◽  
Content Type ◽  
Fine Print

✓ Thirty-three intervertebral disc patients who otherwise would have been subjected to surgery were treated by injection with chymopapain. The pharmacology, toxicology, physiology, immunology, and chemical action of this enzyme, which specifically reacts with chondromucoproteins, are discussed. Results indicate that this method, although still experimental and unapproved by the U. S. Food and Drug Administration, may become a useful addition to the surgeon's armamentarium in the treatment of intervertebral disc disease.

Chymopapain treatment of intervertebral disc disease

1975 ◽  
Vol 42 (4) ◽  
pp. 374-383 ◽  
Author(s):  
Clark Watts ◽  
Robert Knighton ◽  
George Roulhac
Keyword(s):  
Intervertebral Disc ◽  
Proteolytic Enzyme ◽  
Intervertebral Disc Disease ◽  
Disc Disease ◽  
Disc Space ◽  
Content Type ◽  
Disc Material ◽  
Capillary Endothelial Cells ◽  
Fine Print ◽  
Rapid Conversion

✓ In the first of a two-part study, the authors review the known biochemical, pharmacological, toxicological, and experimental data concerning chymopapain and the intervertebral disc. They describe the action of this proteolytic enzyme, which apparently disrupts the protein mucopolysaccharide component of disc material, most marked in the nucleus pulposus. A rapid conversion to collagen causes a loss of disc space height; toxicity appears to result from alteration of bonding between capillary endothelial cells that in turn produces hemorrhage. Part 2 reviews significant reported results and complications of clinical chemonucleolysis.

Late results of treatment of intervertebral disc disease with chymopapain

1983 ◽  
Vol 59 (6) ◽  
pp. 990-993 ◽  
Author(s):  
Dwight Parkinson
Keyword(s):  
Intervertebral Disc ◽  
First Generation ◽  
Clinical Pathology ◽  
Late Results ◽  
Intervertebral Disc Disease ◽  
Disc Disease ◽  
Content Type ◽  
Results Of Treatment ◽  
Fine Print

✓ The authors report a 12-year follow-up review of 33 patients treated with chymopapain (Discase) injection for intervertebral disc disease. This carefully controlled series of patients was treated under local anesthesia in the prone position. Only the single offending disc that correlated with the myelographic and clinical pathology (without the use of discography) was injected with Discase. Anaphylaxis is treated instantly at the first sign of disturbance, and no patients suffered shock. The percentage of patients who were completely cured or improved continues at about 70%. Aside from sensitivity, complications attributable to proper use of the enzyme remain at zero. Follow-up review of those patients over 10 years would indicate that there is no risk of delayed organ toxicity, no risk of carcinogenesis, and no apparent risk of first-generation teratogenesis.

Inadequacies and hazards of chymopapain injections as treatment for intervertebral disc disease

1975 ◽  
Vol 42 (4) ◽  
pp. 389-396 ◽  
Author(s):  
Bernard J. Sussman
Keyword(s):  
Intervertebral Disc ◽  
Nucleus Pulposus ◽  
Neural Tissue ◽  
Intervertebral Disc Disease ◽  
Disc Disease ◽  
Content Type ◽  
Fine Print

✓ The author reviews laboratory and clinical reports that lead him to believe that chymopapain does not specifically dissolve the nucleus pulposus and is toxic for vascular and neural tissue.

Comparison of intervertebral disc disease treatment by chymopapain injection and open surgery

1975 ◽  
Vol 42 (4) ◽  
pp. 397-400 ◽  
Author(s):  
Clark Watts ◽  
Gary Hutchison ◽  
Jack Stern ◽  
Kemp Clark
Keyword(s):  
Intervertebral Disc ◽  
Open Surgery ◽  
Intervertebral Disc Disease ◽  
Disc Disease ◽  
Disease Treatment ◽  
Lumbar Intervertebral Disc ◽  
Content Type ◽  
Fine Print

✓ Chymopapain chemonucleolysis was performed on 100 patients with primary lumbar intervertebral disc disease. The results were compared with those of 174 patients who underwent laminotomy, foraminotomy, and discectomy. Primary lumbar intervertebral disc disease was arbitrarily divided into degenerative, complex, previous surgical, and simple disc syndromes. No difference was seen between chemonucleolysis and surgery in the first three divisions; between 55% and 60% of patients responded successfully to treatment. In the simple disc division 89% of the surgical and 60% of the chemonucleolysis patients had successful results.

Neurosurgical materials and devices

1976 ◽  
Vol 45 (3) ◽  
pp. 251-258 ◽  
Author(s):  
Charles V. Burton ◽  
Joseph T. McFadden
Keyword(s):  
Medical Device ◽  
Drug Administration ◽  
Medical Devices ◽  
Food And Drug Administration ◽  
International Standards ◽  
Current Status ◽  
Reference Source ◽  
Legal Authority ◽  
Content Type ◽  
Fine Print

✓ The current status of voluntary consensus standards writing procedures in neurosurgery and the current progress of government efforts to regulate materials and devices are described. A survey of the national and international standards writing bodies is presented, along with an introduction to related organizations and agencies and nomenclature. The intent of this review is to provide the neurosurgeon with a reference source regarding past and present neurosurgical activities in the materials and devices field. When President Ford signed the 1976 Medical Device Amendments on May 28, 1976, the Food and Drug Administration assumed direct legal authority to control medical devices and potentially assumed the power to regulate those professionals using them.

Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease

2002 ◽  
Vol 96 (1) ◽  
pp. 17-21 ◽  
Author(s):  
Crispin Wigfield ◽  
Steven Gill ◽  
Richard Nelson ◽  
Ilana Langdon ◽  
Newton Metcalf ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Sagittal Plane ◽  
Autologous Bone Graft ◽  
Intervertebral Discs ◽  
Cervical Disc ◽  
Adjacent Level ◽  
Disc Disease ◽  
Content Type ◽  
Flexion Extension ◽  
Fine Print

Object. The authors report the preservation of motion at surgically treated and adjacent spinal segments after placing an artificial cervical joint (ACJ) and they describe the influence of interbody fusion on changes in angulation occurring in the sagittal plane at adjacent levels in the treatment of cervical spondylosis. Methods. The authors conducted a prospective nonrandomized study of patients in whom an ACJ was placed or autologous bone graft interbody fusion was performed. Angular measurements at levels adjacent to that surgically treated were calculated using plain flexion—extension radiographs obtained at 6-month intervals. Analyses of qualitative data, such as increase or decrease in adjacent-level motion, and the degree of disc degeneration were performed. Quantitative data were also analyzed. In the fusion group a significant increase in adjacent-level movement was demonstrated at the 12-month follow-up visit compared with the group of patients in whom ACJs were placed (p < 0.001). The increase in movement occurred predominantly at intervertebral discs that were preoperatively regarded as normal (p < 0.02). An overall reduction in adjacent-level movement was observed in patients who underwent joint replacement, although this was compensated for by the movement provided by the ACJ itself. Conclusions. Fusion results in increased motion at adjacent levels. The increase in adjacent-level motion derives from those discs that appear radiologically normal prior to surgery. It remains unknown whether ACJs have a protective influence on adjacent intervertebral discs.

scholarly journals Two-year observation of artificial intervertebral disc replacement: results after supplemental ultra—high strength bioresorbable spinal stabilization

2004 ◽  
Vol 100 (4) ◽  
pp. 337-342 ◽  
Author(s):  
Yoshihisa Kotani ◽  
Kuniyoshi Abumi ◽  
Yasuo Shikinami ◽  
Masahiko Takahata ◽  
Ken Kadoya ◽  
...  
Keyword(s):  
Intervertebral Disc ◽  
Bone Ingrowth ◽  
Intervertebral Discs ◽  
Disc Replacement ◽  
Segmental Mobility ◽  
Content Type ◽  
Spinal Stabilization ◽  
Titanium Screws ◽  
Flexion Extension ◽  
Fine Print

Object. This 2-year experimental study was conducted to investigate the efficacy of a bioactive three-dimensional (3D) fabric disc for lumbar intervertebral disc replacement. The authors used a bioresorbable spinal fixation rod consisting of a forged composite of particulate unsintered hydroxyapatite/poly-l-lactide acid (HA/PLLA) for stability augmentation. The biomechanical and histological alterations as well as possible device-related loosening were examined at 2 years postoperatively. Methods. Two lumbar intervertebral discs (L2–3 and L4–5) were replaced with the 3D fabric discs, which were augmented by two titanium screws and a spanning bioresorbable rod (HA/PLLA). The segmental biomechanics and interface bone ingrowth were investigated at 6, 15, and 24 months postoperatively, and results were compared with the other two surgical groups (3D fabric disc alone; 3D fabric disc with additional anterior instrumentation stabilization). The 3D fabric disc and HA/PLLA—spinal segments demonstrated segmental mobility at 15 and 24 months; however, the range of motion (ROM) in flexion—extension decreased to 49 and 40%, respectively, despite statistically equivalent preserved torsional ROM. Histologically there was excellent osseous fusion at the 3D fabric disc surface—vertebral body interface. At 2 years posttreatment, no adverse tissue reaction nor aseptic loosening of the device was observed. Conclusions. Intervertebral disc replacement with the 3D fabric disc was viable and when used in conjunction with the bioresorbable HA/PLLA spinal augmentation. Further refinements of device design to create a stand-alone type are necessary to obviate the need for additional spinal stabilization.

scholarly journals FGF4 retrogene on CFA12 is responsible for chondrodystrophy and intervertebral disc disease in dogs

2017 ◽  
Vol 114 (43) ◽  
pp. 11476-11481 ◽  
Author(s):  
Emily A. Brown ◽  
Peter J. Dickinson ◽  
Tamer Mansour ◽  
Beverly K. Sturges ◽  
Miriam Aguilar ◽  
...  
Keyword(s):  
Intervertebral Disc ◽  
Skeletal Dysplasia ◽  
Mammalian Species ◽  
Intervertebral Discs ◽  
Long Bone ◽  
Intervertebral Disc Disease ◽  
Disc Disease ◽  
Association Analyses ◽  
Genome Wide ◽  
Selective Elimination

Chondrodystrophy in dogs is defined by dysplastic, shortened long bones and premature degeneration and calcification of intervertebral discs. Independent genome-wide association analyses for skeletal dysplasia (short limbs) within a single breed (PBonferroni = 0.01) and intervertebral disc disease (IVDD) across breeds (PBonferroni = 4.0 × 10−10) both identified a significant association to the same region on CFA12. Whole genome sequencing identified a highly expressed FGF4 retrogene within this shared region. The FGF4 retrogene segregated with limb length and had an odds ratio of 51.23 (95% CI = 46.69, 56.20) for IVDD. Long bone length in dogs is a unique example of multiple disease-causing retrocopies of the same parental gene in a mammalian species. FGF signaling abnormalities have been associated with skeletal dysplasia in humans, and our findings present opportunities for both selective elimination of a medically and financially devastating disease in dogs and further understanding of the ever-growing complexity of retrogene biology.

Cost—benefit value of microscopic examination of intervertebral discs

1998 ◽  
Vol 89 (3) ◽  
pp. 378-381 ◽  
Author(s):  
Dana M. Grzybicki ◽  
Edward J. Callaghan ◽  
Stephen S. Raab
Keyword(s):  
Intervertebral Disc ◽  
Histological Examination ◽  
Clinical Diagnosis ◽  
Cost Benefit ◽  
Intervertebral Discs ◽  
Pathological Diagnosis ◽  
Histopathological Diagnosis ◽  
Content Type ◽  
Virtual Absence ◽  
Fine Print

Object. Given the virtual absence of histologically detected, clinically unsuspected disease in intervertebral disc specimens, some authors have advocated that histological examination be discontinued. However, the examination of intervertebral disc specimens remains common practice in most pathology laboratories. No cost—benefit analysis of this practice has been made; therefore, the authors' goal in this study was perform such an analysis. Methods. Using the University of Iowa surgical pathology database, 1109 patients who had undergone a laminectomy were identified retrospectively. These cases were classified into four categories based on the patients' preoperative clinical diagnosis and final histopathological diagnosis: insignificant clinical diagnosis/insignificant pathological diagnosis (ICIP), significant clinical diagnosis/insignificant pathological diagnosis (SCIP), significant clinical diagnosis/significant pathological diagnosis (SCSP), and insignificant clinical diagnosis/significant pathological diagnosis (ICSP). A significant clinical diagnosis was defined as one other than a benign, noninfectious indication for laminectomy. A significant pathological diagnosis was a diagnosis other than degenerative changes. The cost—benefit value of performing a histological examination in cases with significant or insignificant clinical diagnoses was examined. The cases were classified as: 1068 ICIP, 17 SCIP, 21 SCSP, and three ICSP. On chart review, in all three cases of ICSP an epidural abscess was identified perioperatively and the subsequent histological diagnosis did not affect patient care. The costs per case of identifying a significant pathological diagnosis with a significant and an insignificant clinical diagnosis were $44.79 and $8811, respectively. Conclusions. Histological examination of intervertebral disc specimens is cost beneficial only if there is a significant preoperative clinical diagnosis.

‘Rumours of my death may have been greatly exaggerated’: a brief review of cell death in human intervertebral disc disease and implications for cell transplantation therapy

2007 ◽  
Vol 35 (4) ◽  
pp. 680-682 ◽  
Author(s):  
W.E.B. Johnson ◽  
S. Roberts
Keyword(s):  
Cell Death ◽  
Intervertebral Disc ◽  
Intervertebral Discs ◽  
Intervertebral Disc Disease ◽  
Disc Disease ◽  
Extensive Cell Death ◽  
Disc Cells ◽  
Extensive Cell ◽  
Cell Transplantation Therapy ◽  
Transplantation Therapy

The avascular nature of the human intervertebral disc is thought to reduce the ability of resident disc cells to maintain their extracellular matrix, rendering the tissue susceptible to degeneration. It has also been suggested that the lack of a blood supply may result in disc cell death via nutrient deprivation. Therefore transplanting new cells into the disc to promote tissue regeneration would be akin to ‘putting cells in a coffin’ and doomed to failure. This review considers the available evidence for cell death in the human intervertebral disc, describing briefly the methods used to assay such death, and concludes that further analysis is required to ascertain whether extensive cell death truly is a marked feature of human intervertebral discs and whether it bears any relationship to disc degeneration and hence regenerative strategies.

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