Chemonucleolysis: an evolving concept and clinical review.

Chemonucleolysis has had a controversial 20 years of probation, and despite growing clinical evidence supporting the efficacy of chymopapain, the concept is still disputed. To evaluate chemonucleolysis 84 patients, treated with chymopapain over 12 months, were assessed before injection and reviewed 5-15 months after injection. All patients had lumbar disc disease which had failed to respond to conservative therapy. Chemonucleolysis was most effective in those patients with classical signs and symptoms of prolapsed lumbar disc disease of less than 3 months' duration and where sciatica was the predominant complaint. Poor results were obtained in those patients with pain for more than 6 months' duration and with predominantly low back pain. Workers' compensation patients did not respond favourably. Good short term results with chemonucleolysis can be expected by careful patient selection and adequate and accurate placement of enzyme.