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.

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.

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.

Diabetic polyradiculopathy simulating lumbar disc disease

1984 ◽  
Vol 60 (1) ◽  
pp. 183-186 ◽  
Author(s):  
Leonard F. Hirsh
Keyword(s):  
Lumbar Disc ◽  
Spinal Nerve ◽  
Spinal Diseases ◽  
Endocrine Disorders ◽  
Disc Disease ◽  
Nerve Roots ◽  
Lumbar Disc Disease ◽  
Content Type ◽  
The Common ◽  
Neurological Effects

✓ Most clinicians are aware of the common neurological effects of endocrine disorders. However, involvement of the spinal nerve roots is a poorly recognized complication of diabetes mellitus. Such involvement can closely simulate more common spinal diseases and thus lead to inappropriate therapy. Four cases of diabetic polyradiculopathy simulating lumbar disc disease are reported, and this distinctive entity is reviewed.

scholarly journals A Retrospective Observational Analysis on the Outcome of Microlumbar Discectomy among 70 Consecutive Cases in the Tertiary Care Spine Center in Nepal

2019 ◽  
Vol 16 (3) ◽  
pp. 34-39
Author(s):  
Binod Bhattarai ◽  
Shashi Bhushan Sah
Keyword(s):  
Wound Infection ◽  
Lumbar Disc ◽  
Tertiary Care ◽  
Lumbar Discectomy ◽  
Neurological Deficits ◽  
Disc Disease ◽  
Term Outcome ◽  
Lumbar Disc Disease ◽  
Long Term Outcome

Lumbar disc disease is a commonly encountered spine problem. There have been various modalities of treatment that have evolved over the years. The objective of our study is to analyze safety, efficacy, and complications following Micro-lumbar discectomy. All the cases admitted in our spine clinic with symptomatic lumbar disc and who underwent Micro-lumbar discectomy between February2013 to February 2018 were included in our study. Seventy cases were operated during this period. Total operative time, immediate and long term outcome with regards to pain and neurological deficits were tabulated and analyzed for each patient. Furthermore, short and long term complications including wound infection, discit is, instability and recurrence at the same level were also studied and compared with similar studies from the literature. None of our cases had complications related to wound infection, instability or post-operativediscitis. Immediate relief from the radicular pain experienced in the pre-operative period was seen in all patients (Visual analog scale) though benign tingling sensation persisted in a few of them that improved in a short span of time. Recurrence was seen in only one case. Micro-lumbar discectomy is a minimally invasive spine procedure conferring high benefits to the patients. While compared to other methods of intervention, it has a low risk of complications as well as chances of disc recurrences.

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.

Surgical experience following intervertebral discolysis with collagenase

1986 ◽  
Vol 64 (4) ◽  
pp. 613-616 ◽  
Author(s):  
Robert G. Fisher ◽  
John W. Bromley ◽  
George L. Becker ◽  
Mark Brown ◽  
Vert Mooney
Keyword(s):  
Surgical Intervention ◽  
Lumbar Disc ◽  
Enzyme Treatment ◽  
Surgical Experience ◽  
Disc Disease ◽  
Disc Space ◽  
Lumbar Disc Disease ◽  
Content Type ◽  
Space Infection ◽  
Herniated Lumbar Disc

✓ Of 410 patients with refractory herniated lumbar disc disease treated with intradiscal collagenase, 82 (20%) did not respond to enzyme treatment and subsequently underwent surgery. Failure to improve in 6 to 8 weeks was the predominant cause for surgical intervention (53 patients). Increased pain (18 patients), progressing neurological deficit (10 patients), and disc-space infection (one patient) were the other indications for surgery. At surgery, extrusions and/or sequestrations were found in 46 patients, undigested protrusions in 16 patients, and other causes of treatment failure in 14 patients. Six patients had normal findings. There was no evidence of adverse enzyme activity on the surrounding structures. Surgical results showed an overall success rate of 87%, and did not appear to be compromised by the previous enzyme therapy.

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