Abdel-Salam A, Eyres K S, Cleary J
Department of Orthopaedics, Huddersfield Royal Infirmary.
Br J Rheumatol. 1992 Jul;31(7):491-3. doi: 10.1093/rheumatology/31.7.491.
Back spasm, or spasm of the back muscles, is the commonest adverse reaction encountered after chemonucleolysis. In order to overcome this troublesome complication, the authors present a new 'paradiscal injection technique'. After the injection of chymopapain into the affected disc, the needle is withdrawn to just outside the annulus. Bupivacaine is injected into the paradiscal 'space' which acts upon the paravertebral muscles. Eighty consecutive patients have been treated by chemonucleolysis with paradiscal injection for pain relief. All patients were discharged the same day or the following day and no immediate complications occurred. When reviewed 3 weeks later, only three (3.8%) patients complained of back pain (which was different in character to that present before the injection or was exacerbated by the injection). Pain persisted in the same patients until 6 months after the injection but was negligible. None of the remaining patients had developed back pain as a result of chymopapain. The authors suggest that the addition of paradiscal injection of bupivicaine after cymopapain injection can reduce the incidence of spasm of the back muscles. This technique is a major contribution to increasing the efficacy of chemonucleolysis for the treatment of herniated lumbar disc.
背部痉挛，即背部肌肉痉挛，是化学髓核溶解术后最常见的不良反应。为了克服这一棘手的并发症，作者们提出了一种新的“椎间盘旁注射技术”。在将木瓜凝乳蛋白酶注入患椎间盘后，将针头退至纤维环外侧。将布比卡因注入椎间盘旁“间隙”，其作用于椎旁肌肉。连续80例患者接受了化学髓核溶解术联合椎间盘旁注射以缓解疼痛。所有患者均在当日或次日出院，未发生即刻并发症。3周后复查时，只有3例（3.8%）患者抱怨背部疼痛（疼痛性质与注射前不同或因注射而加重）。这些患者的疼痛一直持续到注射后6个月，但程度轻微。其余患者均未因木瓜凝乳蛋白酶而出现背部疼痛。作者们认为，在注射木瓜凝乳蛋白酶后加用椎间盘旁注射布比卡因可降低背部肌肉痉挛的发生率。这项技术对提高化学髓核溶解术治疗腰椎间盘突出症的疗效有重要贡献。
