Sutton J C
Neurochirurgia (Stuttg). 1986 Sep;29 Suppl 1:173-8. doi: 10.1055/s-2008-1054105.
Chemonucleolysis is the most selective and least invasive technique available for the treatment of lumbar disc herniations which have failed to respond to conservative therapy. The technique of lateral discography is extremely exacting and should only be carried out by skilled surgeons who are highly trained in the management of lumbar disc disease. The risk of anaphylaxis following the injection of Chymopapain has been greatly reduced by premedicating patients with histamine I and histamine II receptor antagonists. Severe neurological complications are seen in 0.027% of cases treated. Factors contributing to this serious complication are discussed in detail. As with any surgical procedure patient selection is the most critical factor when classifying results following this form of therapy. When chemonucleolysis is reserved for patients who have sciatica as their major complaint, who demonstrate marked objective findings of nerve root compression, and have a posterolateral disc herniation confirmed by water soluble myelography or CAT scan, over 90% of these patients will be spared a surgical procedure.
化学髓核溶解术是治疗对保守治疗无反应的腰椎间盘突出症最具选择性且侵入性最小的技术。侧方椎间盘造影技术要求极高，应由在腰椎间盘疾病管理方面受过高度培训的熟练外科医生进行。通过给患者使用组胺I和组胺II受体拮抗剂进行预处理，注射木瓜凝乳蛋白酶后发生过敏反应的风险已大大降低。在接受治疗的病例中，严重神经并发症的发生率为0.027%。详细讨论了导致这种严重并发症的因素。与任何外科手术一样，在对这种治疗方式的结果进行分类时，患者选择是最关键的因素。当化学髓核溶解术仅用于以坐骨神经痛为主要症状、有明显神经根受压客观体征且经水溶性脊髓造影或计算机断层扫描证实为后外侧椎间盘突出的患者时，超过90%的这些患者将无需进行手术。
