Chemonucleolysis. Current status and future outlook.

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.