A comparison of discectomy and chemonucleolysis.

When comparing two treatment modalities in the care of a herniated nucleus pulposus causing unremitting sciatica, it is difficult to be certain of complete accuracy, despite attentive evaluation. Eight series of patients are presented which compare the effectiveness of discectomy versus chemonucleolysis. Overall evaluation concludes that a similar success rate is obtained as an end result with proper patient selection, technically acceptable treatment, and intelligent follow-up study. Assured potency of the chymopapain is an added consideration in chemonucleolysis. There is evidence of significant decrease in hospitalization time and morbidity in the good result with chymopapain injection. The major advantage of a successful result in the use of chymopapain over discectomy is the absence of postoperative fibrosis, a compelling reason for the consideration of the enzyme in the treatment of a herniated nucleus pulposus where conservative measures have failed.