Chemonucleolysis (discolysis) with collagenase.

Fifty-four patients with proven lumbar disc displacement were treated by intradiscal injection of collagenase (Nucleolysin) between April 1981 and January 1984. Follow-up by history and physical examination, phone survey, and/or mail survey shows 72% success rate (excellent, good, and fair) and 28% poor or unsuccessful results. No patient was made worse by the treatment. Success rate was greater in patients older than the age of 50 years, male patients, and patients with pain complaints of longer than 4 months' duration. The presence of a list and/or crossed straight leg raising and/or straight leg raising positive less than 30 degrees was associated with a poor prognosis. Discography prior to collagenase injection did not compromise the outcome of treatment. Postinjection changes in the CT scan correlated with a satisfactory outcome of treatment. Findings at surgery in patients who failed to obtain relief following collagenase injection did not show a specific deleterious effect of the enzyme, nor were the expected results from surgery compromised by a previous unsuccessful intradiscal collagenase injection.