Chymopapain in perspective.

Three hundred fifty-nine patients with herniated nucleus pulposus syndrome were treated by chemonucleolysis with chymopapain. Good to excellent results were achieved in 71% with a minimum of six months follow-up observation. In a group followed for an average of ten years, the result was favorable in 86.6%; 58% of all patients injected had a good to excellent long-term result. Disc space narrowing averaged 2 mm, with no adverse effect on the result. Firm conclusions about the cause of failure of chemonucleolysis could not be drawn. Injection at two levels was recommended when a single offending level could not be identified. There were no cases of anaphylaxis with a premedication regimen of dexamethasone, diphenhydramine, and cimetidine. The procedure was safe and the results were reproducible.