Comparison of Chemonucleolysis with Chymopapain to Percutaneous Automated Discectomy: A Surgeon’s First 50 Cases of Each

Abstract

The results of one surgeon’s first 50 patients treated with chemonucleolysis with chymopapain are compared to the first 50 patients treated with percutaneous automated discectomy.

The use of chymopapain in nucleolysis of a herniated lumbar disc has been involved in controversy since its beginning, 24 years ago. Its utilization increased significantly and then stopped abruptly because of the realization of its complications. Ninety percent of all complications associated with the use of chymopapain in chemonucleolysis were associated with surgeons who had done ten or less procedures [3]. For this obvious reason, the complications of this drug are less when utilized in medical centers where considerably higher number of these procedures are performed. It is appropriate, therefore, to analyze one’s first experience with any new surgical procedure. I will compare the efficacy and complications of my first 50 chemonucleolysis with chymopapain performed in 1983 to the first 50 cases of percutaneous automated discectomy performed since 1987. The recommended protocols for both of these different surgical procedures were followed in detail [1, 2].