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.

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.

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.

Residual herniated disc material following hemilaminectomy in chondrodystrophic dogs with thoracolumbar intervertebral disc disease

2012 ◽  
Vol 25 (02) ◽  
pp. 109-115 ◽  
Author(s):  
M. Thomas ◽  
J. M. Weh ◽  
J. Bleedorn ◽  
K. Wells ◽  
W. J. Roach
Keyword(s):  
Intervertebral Disc ◽  
Herniated Disc ◽  
Intervertebral Disc Disease ◽  
Disc Disease ◽  
Vertebral Canal ◽  
Telephone Interviews ◽  
Disc Material ◽  
Long Term Follow Up

SummaryObjective: To evaluate the presence of residual disc material within the vertebral canal following hemilaminectomy in chondrodystrophic dogs with thoracolumbar intervertebral disc disease.Methods: Forty dogs were treated by hemilaminectomy. Computed tomography was performed preoperatively and immediately postoperatively. The vertebral canal height, width, area, and herniated disc material area were measured. Maximum filling percentage (MFP), residual disc percentage (RDP), maximum residual filling percentage (MRFP), and residual filling percentage (RFP) were calculated. Clinical outcome was determined by telephone interviews.Results: Residual disc material was present in 100% of the dogs. Mean MFP = 55.4% (range 25.9–82.3%; median 56.9%). Mean RDP = 50.3% (range 2.6–155.8%; median 47.9%). Mean MRFP = 30.8% (range 4.9–60%; median 30.1%). Mean RFP = 19.8% (range 4.8–45%; median 19.0%). All dogs were ambulatory with voluntary urination at the long-term follow-up (range: 88–735 days).Clinical significance: Residual disc was present in all dogs following hemilaminectomy for intervertebral disc disease. Residual disc was not associated with failure to achieve functional recovery in these cases.

Intervertebral disc space cyst simulating a recurrent herniated nucleus pulposus

1988 ◽  
Vol 69 (1) ◽  
pp. 137-139 ◽  
Author(s):  
Jordan C. Grabel ◽  
Raphael Davis ◽  
Rosario Zappulla
Keyword(s):  
Intervertebral Disc ◽  
Preoperative Diagnosis ◽  
Relevant Literature ◽  
Radicular Pain ◽  
Lumbar Region ◽  
Intervertebral Disc Space ◽  
Disc Space ◽  
Content Type ◽  
Herniated Nucleus Pulposus ◽  
Fine Print

✓ The case presented is of a patient with an intervertebral disc space cyst producing recurrent radicular pain following microdiscectomy in the lumbar region. Difficulties with the preoperative diagnosis of this and other recurrent radicular syndromes are discussed, and a review of the relevant literature is presented.

scholarly journals Intradural Disc Extrusion in a Dog

2020 ◽  
Vol 48 ◽  
Author(s):  
Angel Ripplinger ◽  
Graciane Aiello ◽  
Mathias Reginatto Wrzesinski ◽  
Marcelo Luís Schwab ◽  
Júlia Da Silva Rauber ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Conservative Treatment ◽  
Intervertebral Disc ◽  
Spinal Canal ◽  
Intervertebral Disc Disease ◽  
Disc Disease ◽  
Disc Material ◽  
Spinal Cord Dysfunction ◽  
Intradural Space ◽  
Disc Extrusion

Background: Intervertebral disc extrusion is an important cause of spinal cord dysfunction in dogs. Intradural localization of the extruded disc material is rare, and is generally associated with a traumatic event or with recurrence of disc extrusion at a previously affected site. We report the clinical presentation, diagnostic workup, and treatment of a dog with intradural intervertebral disc extrusion not preceded by a traumatic event.Case:  A 6-year-old male Dachshund was referred for neurological evaluation due to acute onset of hind-end paralysis preceded by claudication of the left hindlimb. The patient had been receiving conservative treatment to no effect. Neurological examination revealed asymmetric non-ambulatory paraparesis, absence of postural reactions and decreased muscle tone in both hindlimbs, a bilaterally diminished patellar reflex, and a hindlimb withdrawal reflex which was normal on the right and greatly diminished to absent on the left. The lower back was tender to epaxial palpation. Plain radiographs of the lumbar spine in the lateral projection showed calcified material within the spinal canal between the third and fourth lumbar vertebrae. Myelography was suggestively abnormal at the same level, with epidural leakage of contrast at L3-L4. Considering the clinical history, breed, age, neurological signs, and radiographic findings, intervertebral disc disease was suspected despite the inconclusive myelography findings. A dorsolateral lumbar hemilaminectomy was performed. Intraoperatively, the diagnosis was confirmed by visualization of a discolored spinal cord and absence of extradural material. The intradural space was accessed via durotomy. A firm, straw-yellow material was seen compressing the spinal cord and removed. Subsequent histopathological examination confirmed that this material consisted of extruded intervertebral disc contents. Postoperatively, the patient underwent physiotherapy and achieved a satisfactory recovery.Discussion: The most common cause of paraparesis in chondrodystrophic dog breeds is intervertebral disc extrusion. Intradural extrusion of the intervertebral disc is a rare phenomenon, often associated with vigorous exercise that causes laceration of the dura mater, allowing penetration of disc material into the intradural space. Although there were no classic signs of intervertebral disc disease on plain radiography, radiopaque material was visible within the spinal canal, which can occur in cases of calcified intervertebral disc extrusion. Myelography was inconclusive, but the decision was made to operate nevertheless, considering that the patient had not responded to conservative treatment and that surgicaltreatment is the most suitable approach for dogs with non-ambulatory paraparesis or paraplegia secondary to intervertebral disc extrusion. The surgical technique consisted of a hemilaminectomy and durotomy. Our diagnostic suspicion was confirmed intraoperatively, as in most cases of intradural disc extrusion in humans. Intradural disc extrusion is anuncommon phenomenon in dogs, and the diagnosis is usually only established intraoperatively. This unusual variant of intravertebral disc disease should be included in the differential diagnosis of spinal cord dysfunction in chondrodystrophic breeds, even in the absence of a history of trauma or preexisting intervertebral disc disease. Clinical treatment appears ineffective in these cases. Conversely, surgical treatment can yield good outcomes, and even functional recovery.

scholarly journals Classification of Intervertebral Disc Disease

2020 ◽  
Vol 7 ◽  
Author(s):  
Joe Fenn ◽  
Natasha J. Olby ◽  
Keyword(s):  
Intervertebral Disc ◽  
Intervertebral Disc Degeneration ◽  
Clinical Findings ◽  
Intervertebral Disc Disease ◽  
Disc Disease ◽  
Clinical Presentations ◽  
Disc Material ◽  
Definition Of ◽  
Current Systems

Intervertebral disc disease (IVDD) has been recognized in dogs since the 1800s, when the first descriptions of extruded disc material within the vertebral canal were published. In the intervening time our understanding of intervertebral disc pathology in dogs and cats has increased dramatically, with many variations of IVDD described. Whilst the volume of literature and collective understanding of IVDD has expanded, there has also been scope for confusion as the definition of intervertebral disc disease, with its myriad different manifestations, becomes more complicated. A large volume of literature has aimed to combine the use of histopathology, diagnostic imaging and clinical findings to better understand the various ways in which IVDD can be classified. Much of this research has focused on the classification of mechanisms of intervertebral disc degeneration, centering around the differences between, and overlaps in, IVDD in chondrodystrophic and non-chondrodystrophic dog breeds. However, with the increasing availability of advanced imaging modalities allowing more accurate antemortem diagnosis, the concept of IVDD has expanded to include other clinical presentations that may not fit into traditional models of classification of IVDD. This review aims to provide an up to date overview of both historical and current systems of IVDD classification, highlighting the important findings and controversies underpinning them.

Intervertebral bone implants following excision of protruded lumbar discs

1975 ◽  
Vol 42 (4) ◽  
pp. 401-405 ◽  
Author(s):  
Lee A. Christoferson ◽  
Bradford Selland
Keyword(s):  
Conservative Treatment ◽  
Intervertebral Disc ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Intervertebral Disc Space ◽  
Disc Space ◽  
Disc Protrusion ◽  
Content Type ◽  
Back Surgery ◽  
Fine Print

✓ The authors describe a technique whereby a portion of the lamina removed during exposure of an intervertebral lumbar disc protrusion is implanted in the intervertebral disc space following disc excision. An analysis of 456 consecutive cases operated on by this technique and followed from 1 to 10 years is presented. Of the 418 patients followed, 92% indicated they were able to return to their normal activities and were satisfied with the result. Thirty percent of the patients indicated they had required some conservative treatment for recurrent episodes of back or leg pain. Ten patients had subsequent back surgery; only one implant has dislocated.

Perforation of the anterior annulus during lumbar discectomy

1973 ◽  
Vol 38 (4) ◽  
pp. 514-515 ◽  
Author(s):  
William A. Shevlin ◽  
Alfred J. Luessenhop ◽  
John L. Fox ◽  
David C. McCullough
Keyword(s):  
Intervertebral Disc ◽  
Vascular Injury ◽  
Lumbar Discectomy ◽  
Anterior Longitudinal Ligament ◽  
Disc Space ◽  
Lumbar Intervertebral Disc ◽  
Content Type ◽  
Reliable Sign ◽  
Fine Print

✓ A case of retroperitoneal vascular injury during removal of a lumbar intervertebral disc is presented. It is proposed that the rapid escape of irrigating saline through the disc space may serve as a reliable sign of surgical perforation of the anterior annulus and anterior longitudinal ligament prior to the appearance of other signs of vascular injury.

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