The long-term results of chymopapain chemonucleolysis for lumbar disc disease

1986 ◽  
Vol 65 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Robert J. Maciunas ◽  
Burton M. Onofrio
Keyword(s):  
Surgical Procedures ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Long Term Results ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Content Type ◽  
Work Related ◽  
Effective Treatment Modality

✓ The long-term clinical outcome is evaluated for 268 patients after chymopapain chemonucleolysis for radicular complaints referrable to documented intervertebral disc disease. The follow-up period for 92% of these patients was 10 years. No complications due to chymopapain toxicity were observed; 80.1% of patients were relieved of their presenting radicular leg pain and 75.1% were employed at a capacity equal to or more strenuous than before injection. Chemonucleolysis was demonstrated to be a safe and effective treatment modality, with long-term results that compare favorably with those of similarly selected patients undergoing open surgical procedures. In the patients whose chymopapain therapy failed, the outcome of subsequent open surgical procedures was not necessarily compromised by prior chemonucleolysis. A higher rate of failure and subsequent surgical intervention was seen in those patients with injections performed soon after an unsuccessful open procedure on the same side and at the same interspace, those with workmen's compensation or litigation pending, those with a history of work-related injury, those whose employment involved heavy manual labor or extensive driving, and those whose preinjection spine x-ray films indicated retrograde spondylolisthesis.

Chemonucleolysis with chymopapain: results in 150 patients

1987 ◽  
Vol 67 (2) ◽  
pp. 187-191 ◽  
Author(s):  
Christopher B. Shields ◽  
Steven J. Reiss ◽  
Henry D. Garretson
Keyword(s):  
Lumbar Disc ◽  
Third Party ◽  
Daily Activities ◽  
Mail Questionnaire ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Content Type ◽  
Cast Doubt ◽  
Mild Restriction

✓ Chemonucleolysis with chymopapain has been advocated for the treatment of lumbar disc disease. When polled by a mail questionnaire, 150 consecutive patients who had undergone chemonucleolysis reported an overall success rate of only 40% and a failure rate of 60%. However, 57% of the patients were active or had only mild restriction of daily activities. Of those patients employed prior to injection, only 63% had returned to work. Those with workmen's compensation benefits fared considerably worse than those covered by third-party insurance (17% vs. 51% success). These results cast doubt on the long-term benefits of chymopapain in the treatment of lumbar disc disease.

scholarly journals Long term results of Endoscopic Lumbar Discectomy using Side viewing Conical working tube

2018 ◽  
Vol 32 (2) ◽  
pp. 306-313
Author(s):  
Mohammad Kaif ◽  
Kuldeep Yadav ◽  
Mazhar Husain
Keyword(s):  
Low Cost ◽  
Lumbar Disc ◽  
Early Mobilization ◽  
Long Term Results ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Endoscopic Discectomy ◽  
Endoscopic Lumbar Discectomy

Abstract Object: Endoscopic discectomy is a common procure performed worldwide with various devices being used and studies have reported their long term results. In this study we present the long term results of the unique device with separate side viewing channel. Methods: 66 patients of lumbar disc herniation treated between March 2009 to April 2012 using the unique conical working tube with separate side viewing endoscopic channel. Their preoperative and postoperative Oswestry Disability Index (ODI) and Macnab scores were used to evaluate the outcome after a minimum follow of 5 years with mean follow up of 76.18 months. Results: There were 46 males and 20 females with age ranging from19-72 (mean-38.4 years). The follow up ranged from 61 months to 95 months with mean of 76.18 months. The mean preoperative ODI score was 74.7 which decreased to a mean of 7.8 and the outcome evaluated by Macnab criteria was 69.69% excellent, 17 % good, 10% fair, 3.03% poor. 2 patients underwent second surgery. None of the patient had to change their occupation due to their lumbar disc disease. Complications occurred were dural tear in 2 patients, transient foot paresis in 1 patient and 1 discitis in 1 patient which improved on medical management. Conclusion: Endoscopic discectomy using thins Conical working tube is a safe and effective technique for lumbar disc prolapse. It has the advantage for early mobilization, short hospital stay and low cost. The long term results are comparable to the conventional techniques.

Encouraging Medium-term Results of Wallis Second Generation Dynamic Stabilisation Device

2018 ◽  
Vol 20 (2) ◽  
pp. 149-156
Author(s):  
Awaiz Ahmed ◽  
Abdulla Jawed ◽  
Murali Venkatesan ◽  
James Doyle
Keyword(s):  
Oswestry Disability Index ◽  
Second Generation ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Medium Term ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Dynamic Stabilisation ◽  
The Mean

Background. Aim of this prospective study was to evaluate safety and efficacy of second generation Wallis system for degenerative lumbar disc disease. Material and methods. 25 patients underwent discectomy and insertion of Wallis system. Outcome assessment was done using Modified Oswestry disability index (ODI) and visual analogue scale (VAS) for backache and leg pain. Results. The mean follow-up was 20.5 months. The mean VAS for backache and leg pain showed significant improvement from 7.2 to 3.0 (p<0.001) and mean modified Oswestry disability index showed significant improvement from 59.1 to 24.7 (p<0.001). Only one patient (4%) underwent revision surgery for persistent pain due to granulation tissue deep to the implant. There were no other complications. Conclusion. The Wallis spine system is a safe and effective implant for treating degenerative lumbar disc disease.

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.

Relationship between Severity of Lumbar Disc Disease and Disability Scores in Sciatica Patients

Neurosurgery ◽  
2002 ◽  
Vol 50 (6) ◽  
pp. 1253-1260 ◽  
Author(s):  
François Porchet ◽  
Vincent Wietlisbach ◽  
Bernard Burnand ◽  
Karine Daeppen ◽  
Jean-Guy Villemure ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Pain Score ◽  
Odds Ratio ◽  
Lumbar Disc ◽  
Pain Scale ◽  
Leg Pain ◽  
Imaging Findings ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Sf 36

Abstract OBJECTIVE To study the association between the clinical examination and the radiological assessment of lumbar disc disease in patients with sciatica. METHODS The study included 394 consecutive sciatica patients. The patients’ disabilities were evaluated by a visual analog pain scale, the Prolo functional-economic rating scale, the modified Roland-Morris disability questionnaire, and the health-related quality of life short form (SF-36) questionnaire. Radiological imaging findings were independently classified according to the Modic criteria into five groups of increasing severity of disc disease. Stepwise multivariate logistic regression was used to determine which scores were significant independent predictors of a severe disc disease (extrusion or sequestration). RESULTS Of these patients, 9.6% had no disc disease, 3.3% had a bulging, 11.4% had a protrusion, 68.5% had an extrusion, and 7.1% had a disc sequestration. Statistically significant positive linear associations with the severity of disc disease were found for the leg pain scale, the Roland-Morris and Prolo disability scales, and the SF-36 scores related to physical functioning, physical role, and bodily pain (all P &lt; 0.005). A poor (&lt;5) Prolo score (odds ratio, 2.91; 95% confidence interval, 1.74–4.87), a higher leg pain score (odds ratio, 1.16 per centimeter increase; 95% confidence interval, 1.07–1.27), and a lower low back pain score (odds ratio, 0.90 per centimeter decrease; 95% confidence interval, 0.82–0.98) were retained in the multivariate logistic model as independent predictors of severe disc disease. CONCLUSION The positive correlation between disability status and imaging findings validates both assessment methods. Routine use of disability scores brings a useful contribution to the assessment of sciatica patients.

Surgical treatment of 63 cases of conjoined nerve roots

1982 ◽  
Vol 56 (1) ◽  
pp. 114-117 ◽  
Author(s):  
James G. White ◽  
Timothy A. Strait ◽  
Joseph R. Binkley ◽  
Samuel E. Hunter
Keyword(s):  
Surgical Treatment ◽  
Lumbar Disc ◽  
Disc Disease ◽  
Nerve Roots ◽  
Lumbar Disc Disease ◽  
Content Type ◽  
Operative Results ◽  
Conjoined Nerve Roots ◽  
Conjoined Nerve Root ◽  
Fine Print

✓ The operative results of 63 cases of lumbar disc disease with surgically confirmed conjoined nerve roots are reviewed. The first 55 patients were treated by standard hemilaminectomy and discectomy, with only 30% reporting a good result. Of the last eight patients treated by hemilaminectomy, pediculectomy, and discectomy, seven patients returned to work. The rationale for and the technique of pediculectomy are discussed in detail. Clinical, radiological, and surgical clues indicating the presence of the conjoined nerve root anomaly are reviewed.

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