Efficacy of chymopapain chemonucleolysis

1985 ◽  
Vol 62 (5) ◽  
pp. 662-666 ◽  
Author(s):  
Manucher J. Javid
Keyword(s):  
Marked Improvement ◽  
Lumbar Disc ◽  
Slight Improvement ◽  
Content Type ◽  
Herniated Lumbar Disc ◽  
Fine Print

✓ A 9- to 12-year follow-up review was conducted in 105 of 124 patients who were treated with chymopapain chemonucleolysis for herniated lumbar disc. The data were obtained from responses to a questionnaire. Seventy-nine patients (75.2%) reported marked improvement, six (5.7%) had slight improvement, and 20 (19.0%) had no improvement. Of the 87 patients not receiving workman's compensation, 70 patients (80.5%) had marked improvement; four (4.6%) had slight improvement; and 13 (14.9%) had no improvement. Of the 18 compensation cases, nine patients (50.0%) had marked improvement; two patients (11.1%) had slight improvement; and seven patients (38.9%) had no improvement. These results are comparable to those reported for surgical discectomy, and confirm that chymopapain chemonucleolysis is an alternative to surgery.

Syndrome of the incidental herniated lumbar disc

1983 ◽  
Vol 59 (1) ◽  
pp. 137-141 ◽  
Author(s):  
James E. Wilberger ◽  
Dachling Pang
Keyword(s):  
Clinical Features ◽  
Lumbar Disc Herniation ◽  
Lumbar Disc ◽  
Herniated Disc ◽  
Content Type ◽  
Asymptomatic Patients ◽  
Appropriate Treatment ◽  
Herniated Lumbar Disc ◽  
Fine Print

✓ Lumbar myelographic defects consistent with herniated disc were found in 108 asymptomatic patients undergoing myelography for other reasons. Within 3 years, 64% of these patients developed symptoms of lumbosacral radiculopathy. The clinical features of these patients comprise a syndrome significantly different from that typically associated with classical lumbar disc herniation: the syndrome described here carries a much higher incidence of silent root compression with minimal pain. Incidental lumbar myelographic defects are not necessarily benign findings, and patients in whom they are encountered deserve close clinical follow-up review and appropriate treatment if the defects become symptomatic.

Lumbar disc protrusion in children

1981 ◽  
Vol 54 (4) ◽  
pp. 480-483 ◽  
Author(s):  
Robert G. Fisher ◽  
Richard L. Saunders
Keyword(s):  
Differential Diagnosis ◽  
Adult Patient ◽  
Lumbar Disc ◽  
Disc Protrusion ◽  
Content Type ◽  
Sciatic Pain ◽  
Major Complications ◽  
Refractory Case ◽  
Fine Print

✓ Forty-three cases of surgically treated lumbar disc protrusion in patients 21 years or younger are analyzed. The results were generally good. Ten percent of the patients required reoperation within 3 years. No major complications were experienced. Follow-up observation ranged from 4 to 30 years. Disc protrusion should be considered in the differential diagnosis of children with back and sciatic pain, and early myelography should be carried out in the refractory case. The symptoms, signs, myelograms, and surgical findings are usually similar to those of the adult patient with a disc protrusion.

Unilateral facetectomy approach for lateral lumbar disc herniation

1991 ◽  
Vol 74 (5) ◽  
pp. 754-756 ◽  
Author(s):  
Eddy Garrido ◽  
P. Noel Connaughton
Keyword(s):  
Disc Herniation ◽  
Lumbar Fusion ◽  
Lumbar Disc ◽  
Herniated Disc ◽  
Spinal Instability ◽  
Content Type ◽  
X Ray ◽  
Flexion And Extension ◽  
Fine Print

✓ Forty-one patients with herniated lumbar discs in a lateral location underwent unilateral complete facetectomy for removal of their disc herniation. The diagnosis was made by computerized tomography in all patients. The follow-up period varied between 4 and 60 months, with an average of 22.4 months. All patients underwent dynamic lumbar spine x-ray films with flexion and extension exposures at various times during their follow-up period. The results were excellent in 35 patients, good in three, and poor in three. One patient suffered spinal instability postoperatively and required lumbar fusion because of back pain. Unilateral facetectomy gives an excellent view of the affected nerve root and the herniated disc, and the risk of spinal instability is very low.

Extraosseous extradural tuberculous granuloma simulating a herniated lumbar disc

1971 ◽  
Vol 35 (4) ◽  
pp. 488-490 ◽  
Author(s):  
S. Balaparameswara Rao ◽  
I. Dinakar ◽  
K. Sreenivasa Rao
Keyword(s):  
Cerebrospinal Fluid ◽  
Granulation Tissue ◽  
Lumbar Disc ◽  
Disc Prolapse ◽  
Content Type ◽  
X Ray ◽  
Herniated Lumbar Disc ◽  
Tuberculous Granuloma ◽  
Fine Print

✓ A 25-year-old man with left-sided sciatica, in whom the cerebrospinal fluid and x-ray films of the spine were normal, was diagnosed as having a L5-S1 disc prolapse. At surgery extradural, extraosseous granulation tissue was removed, which histologically proved to be a tuberculous granuloma.

Intraradicular herniated lumbar disc

1984 ◽  
Vol 60 (4) ◽  
pp. 858-860 ◽  
Author(s):  
José Barberá ◽  
José Gonzalez-Darder ◽  
Fernando García-Vazquez
Keyword(s):  
Nerve Root ◽  
Unusual Case ◽  
Lumbar Disc ◽  
Content Type ◽  
Pathogenic Factors ◽  
Herniated Lumbar Disc ◽  
Fine Print

✓ An unusual case is presented in which a fragment of herniated lumbar disc was found within the sheath of the S-1 nerve root. The possible pathogenic factors are discussed.

Postchemonucleolysis discectomy versus repeat discectomy: a prospective 1- to 13-year comparison

1996 ◽  
Vol 85 (2) ◽  
pp. 231-238 ◽  
Author(s):  
Manucher J. Javid
Keyword(s):  
Success Rate ◽  
Lumbar Disc ◽  
Clinical Results ◽  
Long Term Results ◽  
Content Type ◽  
Employment Rates ◽  
Second Procedure ◽  
Fine Print

✓ This long-term prospective study evaluates the clinical results of subsequent laminectomy in 103 consecutive patients who initially underwent chemonucleolysis (CNL) or laminectomy for lumbar disc herniation. Between 1981 and 1994, 53 patients who had received CNL initially and then underwent laminectomy and 50 patients treated initially with laminectomy underwent a repeat laminectomy. Clinical assessment at 6 weeks showed a success rate of 80.8% for post-CNL laminectomy and 78% for repeat laminectomy. At 6 months, the success rate for patients treated with CNL was 86% versus 78.7% for laminectomy. At 12 months, the overall success rate for the CNL group was 80.4% versus 83.3% for the laminectomy group, but in patients who had not obtained relief from the first procedure the success rate for the second procedure was higher for the post-CNL patients. A questionnaire was sent to all patients for 1- to 13-year follow-up review. The average follow-up period was 6.6 years for post-CNL laminectomy and 5.2 years for repeat laminectomy. The long-term success rate (81.8%) was higher in the post-CNL group compared to 64.4% in the repeat laminectomy group. Seven patients in the post-CNL group and nine in the repeat laminectomy group had undergone a third operation. When these originally successfully treated patients were reassigned after unsuccessful outcomes, the success rate for the CNL groups was 72.7%, versus 51.1% in the laminectomy group (p = 0.049). Employment rates were 80% for patients with CNL (21.8% changed jobs) and 76.3% for patients undergoing laminectomy (48.3% changed jobs) (p = 0.036). In conclusion, patients who underwent laminectomies after receiving CNL had significantly better long-term results than those who had repeat laminectomies.

Disappearing cervical disc

1997 ◽  
Vol 86 (2) ◽  
pp. 289-290 ◽  
Author(s):  
Richard M. Westmark ◽  
Kaye D. Westmark ◽  
Volker K. H. Sonntag
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Lumbar Disc ◽  
Spontaneous Resolution ◽  
Herniated Disc ◽  
Cervical Disc ◽  
Resonance Imaging ◽  
Content Type ◽  
Herniated Lumbar Disc ◽  
Fine Print

✓ The authors report the case of a 48-year-old woman who experienced spontaneous resolution of a large herniated disc at C6–7. Spontaneous resolution of a herniated lumbar disc was first documented by computerized tomography. This case is another example of a rare spontaneous resolution of a cervical disc herniation documented by magnetic resonance imaging.

Percutaneous automated discectomy: a new method for lumbar disc removal

1987 ◽  
Vol 66 (1) ◽  
pp. 143-146 ◽  
Author(s):  
Joseph C. Maroon ◽  
Gary Onik
Keyword(s):  
Lumbar Disc ◽  
Surgical Excision ◽  
Radicular Pain ◽  
Disc Space ◽  
Content Type ◽  
A New Technique ◽  
Herniated Discs ◽  
Fine Print

✓ A new technique for percutaneous lumbar disc removal is described. The specially designed 2-mm blunt-tipped suction/cutting probe (nucleotome) is similar to the automated vitrectomy instrumentation used by ophthalmic surgeons. The procedure is performed under local anesthesia, with the patient in the prone position and with fluoroscopic guidance. The nucleotome is inserted into the appropriate disc space with specially designed instrumentation, guided by landmarks similar to those used in needle placement for chemonucleolysis. The technique has been evaluated in 20 patients with herniated discs (one at the L3-4 level and 19 at the L4-5 level) confirmed by myelography and/or computerized tomography scans after all conservative therapy for primarily radicular pain had failed. From 1 to 7 gm of disc material was removed in an average total operative time of approximately 1 hour. Eighty percent of the patients had good to excellent results in a short-term follow-up period of 6 months. Four patients subsequently required standard surgical excision of free disc fragments. No significant complications occurred. The procedure is contraindicated in patients with extruded or free fragments of disc in the spinal canal or in patients with herniations at the L5-S1 level pending development of additional instrumentation for insertion at that level. More extensive long-term studies are needed to further evaluate this procedure.

Surgically treated lumbar disc disease in the pediatric population: an outcome study

2000 ◽  
Vol 92 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Susan R. Durham ◽  
Peter P. Sun ◽  
Leslie N. Sutton
Keyword(s):  
Back Pain ◽  
Pediatric Population ◽  
Lumbar Disc ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Content Type ◽  
Sf 36 ◽  
Study Population ◽  
Fine Print

Object. This outcome study was undertaken to investigate the long-term results obtained in surgically treated pediatric patients with lumbar disc disease by using standardized medical outcome scales and clinical follow-up examination. Methods. Twenty nine patients 17 years of age or younger underwent surgery between 1968 and 1998 for lumbar disc disease. The follow-up period ranged from 4 months to 30.5 years (mean 8.5 years). Outcome scores (health profiles) were generated using a standardized medical outcome scale, the Short Form health survey questionnaire (SF-36), and a condition-specific back pain outcome scale. Clinical follow-up data were obtained by telephone interview. The health profile of the study population closely paralleled that of the normal population and was distinctly different from the health profile of adults with low-back pain. Only physical functioning, as measured by a scale of the SF-36, was found to be impaired in a subset of the study population. The rate of reoperation was 24% over the course of the follow-up period. In contrast to similar studies in adults, there were no identifiable predictive factors for either reoperation or poor outcome. Conclusions. Lumbar disc disease in the pediatric population does not appear to lead to chronic complaints of back pain, and it does not appear to have a negative impact on overall health. This finding suggests that pediatric lumbar disc disease may be a separate entity distinct from adult lumbar disc disease, and therefore, the same conclusions regarding long-term outcome cannot be applied to the pediatric population.

Double-blind evaluation of intradiscal chymopapain for herniated lumbar discs

1976 ◽  
Vol 45 (6) ◽  
pp. 622-627 ◽  
Author(s):  
P. Robert Schwetschenau ◽  
Archimedes Ramirez ◽  
James Johnston ◽  
Elnora Barnes ◽  
Albert N. Martins
Keyword(s):  
Conservative Treatment ◽  
Lumbar Disc ◽  
Intractable Pain ◽  
Double Blind ◽  
Content Type ◽  
Early Results ◽  
Significant Difference ◽  
Herniated Lumbar Disc ◽  
Fine Print

✓ The authors report 66 patients with signs, symptoms, and a myelographic abnormality of herniated lumbar disc, who were not responsive to conservative treatment. The discs were injected at random with either chymopapain or a placebo. Neither patient nor surgeon knew which agent was used until after the results had been tabulated. Unless early laminectomy was necessary for intractable pain, all patients were followed for 2 months or more. There was no statistically significant difference in incidence or quality of improvement between the two groups: chymopapain was successful in 58% while placebo was successful in 49% (p = 0.15). Early results from this study indicate that most, if not all, of the putative effectiveness of chemonucleolysis probably derives from a placebo effect.

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