Discography in the Prognosis of Chemonucleolysis

Abstract

Failure after chemonucleolysis in the treatment of prolapsed lumbar intervertebral disc causing root pain in the lower limb is mainly due to psychological problems, stenosis (especially in the lateral recess), and residual disc fragment. This last possibility corresponds to about 70% of operative findings in the Cauchoix and Deburge [5] series and also in Carruthers and Koussaie [3]. In our own series of 31 cases operated after failure of chemonucleolysis, we found that in 21 cases (67%) symptoms were in connection with a remaining discal fragment Operative findings show that these divide into two categories:

• 1) The fragment is extruded and actually separated from the disc space; in theory it cannot be reached by a fluid injected into the disc space, except in the case of epidural leak.

• 2) The fragment is contiguous to the disc; the longitudinal posterior ligament is either ruptured or covers the protruded disc.