A revised objective rating system for patient selection for chymopapain chemonucleolysis.

A revised objective rating system, previously found useful for patient selection for lumbar laminectomy and discectomy, was evaluated in patient selection for chemonucleolysis by intradiscal chymopapain. Based on the severity of findings within each of four categories (neurologic signs, root tension signs, myelogram or computed tomography (CT) findings, and psychosocial environment), numerical scores are derived. A maximum score of 25 points is available in each of four categories for a total of 100 points. The objective rating score was determined in a series of 101 patients prior to treatment of lumbar disc herniation by chemonucleolysis. The patients were evaluated at least one year after injection. The objective rating score was predictive of the result of chemonucleolysis, and was even more strongly predictive of the ultimate surgical outcome, which included the results in 22 patients who were treated by laminectomy after chemonucleolysis failure.