Abstract
Purpose of the Study
Assessment of long term results of Chemonucleolysis vs. surgery for soft disc herniation
Material and Methods
From 1982 to 1985, 100 patients with symptomatic disc herniation were randomly allocated to receive either Chemonucleolysis(48) or surgery(52) after a three months trial of conservative treatment. Ten of the chemonucleolysis had surgery. At 10–13 year follow up, Sixty one of the original 100 patients responded, (32 chemonucleolysis; 29 surgery). At 25–27 year Forty four patients responded (24 chemonucleolysis; 20 surgery). Clinical outcome at one year was according to a self-assessment questionnaire: Completely, better improved, the same, or worse, and at the later follow up periods, according to the Macnab criteria. The results of two groups of patients were compared using Chi square and T test for independent samples.
The disc height of the affected disc was measured from the lateral lumbar spine radiograph taken pre-operatively, and at the later two time points, and compared to a normal adjacent disc expressed as a percentage.
Results
The intent to treat clinical outcome results showed a high success rate at one year (93% chemonucleolysis; 96% surgery completely better or improved); and also at the later two time points with no significant difference between the groups.
The radiological data showed no difference in disc height between the groups at any of the time points with some reduction over time with aging.
Conclusion
There is no difference between the groups in either clinical or radiological outcome over time. Chymopapain, presently not widely available, should be made available again.
No conflict of interest
No funding obtained
This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting.
