The authors analysed the relationship of the discographic finding to the chemonucleolysis results of herniated lumbar disc during May 1984 to January 1987. Among 900 herniated lumbar disc cases, 882 patients were treated with the chymopapain injections. Overall success rate was 87.2%. Discographic findings were devided in five types:I) contained, II) degenerative, III) annular bugling, IV) subligamentous leak, and V) epidural leak type. In 546 one level chemenucleolysis cases the successful rates were different in the discogram types as followings:type V 92.9%, type III 89.1%, type IV 87.5%, type II 85.0% and type I 62.5%. The discography is considered to be useful not only in predicting the chemonucleolysis result, but also in determination of chymopapain injection or not.
Chymopapain ; Humans ; Intervertebral Disc Chemolysis*

After attempts of percutaneous laser disc decompression on 14 patients of lumbar disc herniations, disappointing results were recorded as follows, 2 cases(14.2%) were considered excellent, 2 cases(14.2%) good, 2 cases(14.2%) fair and 8 cases(57.1%) poor. While successfully treated patients had minimal subligamentous extension of nucleus pulposus, failed cases had moderate to severe subligamentous extension of nucleus pulposus through the annular tearing. In preliminary conclusion of percutaneous laser disc decompression, successful result can be expected only on the minimal subligamentous extension cases, and chemonucleolysis will be better choice for the moderate to severe subligamentous extension cases.
Decompression* ; Humans ; Intervertebral Disc Chemolysis

Chymopapain was discovered by Jensen in 1941, and in 1963 Smith demonstrated the chondrolytic properties of chymopapain. Since then, many patients have been injected with this agent. Although there are evidences of neurotoxicity to chymopapain in animals, adverse effects in humans have rarely been reported. We present a case delayed onset of paraplegia after chymopapain chemonucleolysis and review the neurotoxicities to chymopapain.
Animals ; Chymopapain ; Humans ; Intervertebral Disc Chemolysis* ; Paraplegia*

We studied the intradiscal pressure in order to understand the biophysics of the lumbar intervertebral disk. We evaluated the relationship between disk morphology and intradiscal pressure in 90 lumbar intervertebral disks of 64 patients. The intrinsic intradiscal pressure in the ruptured disks was much lower than that in the normal or bulging disk, but intrinsic intradiscal pressure alone did not correlate in a statistically significant way to the absence, or presence and/or type of disk herniation. The elastance of normal disks was statistically significantly higher than that of the protruded disk(p<0.05) ; however, the elastance of lumbar disk was not affected by type of disk protrusion. Factors affecting disk elastance were the degeneration and the integrity of the annulus fibrosus and the posterior longitudinal ligament. The authors experienced no complication during the procedure. The measurement of the intradiscal pressure to evaluated the biophysical function of lumbar intervertebral disks is only a simple and risk-free procedure. Also it is suggested that patients with bulging disks of high elastance may be treated by reducing intradiscal pressure with percutaneous procedures such as chemonucleolysis, and automated discectomy using Nucleotome.
Biophysics ; Diskectomy ; Humans ; Intervertebral Disc Chemolysis ; Intervertebral Disc* ; Longitudinal Ligaments

The authors reviewed the radiographs and medical records of 134 consecutive patients who underwent chemonucleolysis and automated percutaneous lumbar discectomy(APLD) between March 1990 and December 1994 at our institute. Among the 34 consecutive patients, 90 patients underwent chemonucleolysis and the other remaining patients underwent APLD using a nucleotome. The results are summarized as follows: 1) In both groups, predominent patients were of young age and males. 2) The most common lesion was in L4-5 interspace in both groups 3) The posteior lateral type showed high incidence in APLD group. 4) The results were better in the younger age group and when spinal CT demonstrated posterior lateral type in both groups. 5) The results showed relatively good success rate of 84.4% in chemonucleolysis group and 88.6% in APLD group. 6) Better results can be anticipated when patients are carefully selected and operated on with a higher skillful technique.
Diskectomy* ; Humans ; Incidence ; Intervertebral Disc Chemolysis ; Male ; Medical Records ; Spine*

The authors performed chemonucleolysis in 5 patients with cervical disc herniations who were treated at our institution between 1983 to 193. The age of the patients(4 were men and 1 women) ranged from 31 to 53, with the mean age of 44 years. All 5 patients presented with a less than 5-month history of progressive cervicobrachial pain. During a postoperative follow-up period, all patients had marked improvement from the cervico-brachial pain and there was no intraoperative or postoperative complications.
Follow-Up Studies ; Humans ; Intervertebral Disc Chemolysis* ; Male ; Postoperative Complications

Back pain and radiating leg pain due to compression of the nerve root by the lumbar disc herniation are subjective symptoms. Objective evaluation of pain site and severity is important for the diagnosis and the treatment. We evaluate the correlation between the severity of pain and the temperature changes in the patients of lumbar disc herniations using infrared thermograms. 174 consecutive patients who underwent operation or chemonucleolysis for single level unilateral disc protrusion with ipsilateral leg pain were included in this study. Subjective pain was divided four groups(Group I: mild pain, Group II: moderate pain, Group III: severe pain, Group IV: intractable pain). Thermal differences of each group were as follows: Group I was 0.26degreesC, Group II was 0.39degreesC, Group III was 0.60degreesC and Group IV was 0.98degreesC. Disc protrusions were divided three groups. Thermal differences of each group were as follows; mild protrusion group was 0.52degreesC, moderate protrusion group was 0.79degreesC and severe protrusion group was 0.95degreesC. Duration of symptom was divided four groups and each thermal differences were as follows: under 2 months was 0.87degreesC, 2 to 6 months was 0.71degreesC, 6 to 12 months was 0.50degreesC and more than 12 months was 0.47degreesC. All these data were statistically significant in p<0.01. In conclusion, infrared thermal imaging can demonstrate the subjective pain objectively. The discogenic pain is the more severe, or the disc herniation is the more protruded, or the symptom duration is the shorter, the thermal difference between the both legs is the more significantly prominent. Thermal difference between both legs is a useful pain scale in the herniated lumbar disc patients. Infrared thermal imaging is effective in the evaluation of lumbar discogenic pain.
Back Pain ; Diagnosis ; Humans ; Intervertebral Disc Chemolysis ; Leg

The Chemonucleolysis at out-patient clinic(OPD) is a new option in the treatment of lumbar disc herniation. The authors performed 39 cases of Chemonucleolysis with this method since Mar. 1992. All but 2 cases had excellent or good results without any complications. This OPD chemonucleolysis was thought to be a very useful method that gave various benefits to both of the patient and the hospital. To the patient, Socioeconomical and psychological benefits such as cost reduction and short hospital periods would be obtained. And to the hospital, Increasing outcome could be obtained by the improving hospital circulation of the patients who needed admission. For the best results, complete pre-operative evaluation and strict application of indication was essential. Proper home care guide was also needed because the home care was occasionally required from several days to a few months.
Home Care Services ; Humans ; Intervertebral Disc Chemolysis* ; Outpatients*

We had experienced 60 cases of chemonucleolysis with Discase(R)(chymopapain for injection) under careful patient selection of herniated lumbar discs and had followed up thereafter at least 3 months since July, 1984. Therapeutic results were generally favorable, with 90% of patients achieving either excellent or good(satisfactory) results. Three patients only had poor or failure results. There was no major anaphylatic reaction and no serious neurologic complications. Back spasm and stiffness/soreness were the most frequently encountered complications.
Chymopapain ; Humans ; Intervertebral Disc Chemolysis* ; Patient Selection ; Spasm

Digital infrared thermographic imaging system is noninvasive, easy to reading, objective and physiologic instrument by measuring and imaging infrared energy emitted from skin surface. The authors present the result of digital infrared thermographic images of 83 patients of operated lumbar disc herniation from October, 1990 to March, 1991. 46 patients have received discectomy and the other 37 patients have received chemonucleolysis. We have done digital infrared thermographic imaging preoperatively and postoperatively. In preoperative digital infrared thermographic imaging, diagnostic sensitivity is about 76%, In postoperative digital infrared thermographic imaging, clinical results were well correlated in discectomy group. But in chemonucleolysis group, clinical results were not correlated with digital infrared thermographic images.
Diagnostic Imaging ; Diskectomy ; Humans ; Intervertebral Disc Chemolysis ; Skin