Advertisement

Technique of lumbar chemonucleolysis

  • J.-D. Laredo
  • J. Busson
  • M. Wybier
  • M. Bard

Abstract

Intrathecal injection of chymopapain causes fatal hemorrhage in rabbits and dogs [12]. To prevent the possibility of chymopapain leaking into the subarachnoid space, chemonucleolysis should not be performed immediately after myelography in order to allow any dural leak to seal [12]. McCulloch recommends a minimum delay of 24 hours [12]. We agree with other practitioners and require at least seven days between myelography and enzyme injection [1].

Keywords

Iliac Crest Nucleus Pulposus Disc Herniation Facet Joint Disc Space 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Benoist M, Deburge A, Heripret J, Busson J, Rigot J. Cauchoix J (1982) Treatment of lumbar disc herniation by chymopapain chemonucleolysis: a report on 120 patients. Spine 7: 613–617PubMedCrossRefGoogle Scholar
  2. 2.
    Brown JE (1969) Clinical studies on chemonucleolysis. Clin Orthop 67: 94–99PubMedGoogle Scholar
  3. 3.
    Crock HV (1983) Practice of spinal surgery. Springer, Wien New York, pp 40Google Scholar
  4. 4.
    Crock HV (1984) Discography and vertebral venography before chemonucleolysis. J Neurosurg 60: 149–150Google Scholar
  5. 5.
    Crock HV (1986) Chymopapain. Lancet 2: 1159CrossRefGoogle Scholar
  6. 6.
    Dabezies EJ, Murphy CP (1985) Dural puncture using the lateral approach for chemonucleolysis. Spine 10: 93–96PubMedCrossRefGoogle Scholar
  7. 7.
    Day PL (1969) Lateral approach for lumbar discogram and chemonucleolysis. Clin Orthop 67: 90–93PubMedGoogle Scholar
  8. 8.
    Erlacher P (1952) Nucleography. J Bone Joint Surg [Br] 34: 204–210Google Scholar
  9. 9.
    Finneson BE (1973) Low back pain. Lippincott, Philadelphia, pp 69–76Google Scholar
  10. 10.
    Keck C (1960) Discography, technique and interpretation. Arch Surg 80: 580585Google Scholar
  11. 11.
    McCulloch JA (1977) Chemonucleolysis. J Bone Joint Surg [Br] 59: 45–52Google Scholar
  12. 12.
    McCulloch JA (1980) Chemonucleolysis: experience with 2,000 cases. Clin Orthop 146: 35–128Google Scholar
  13. 13.
    McCulloch JA, Waddell G (1978) Lateral lumbar discography. Br J Radiol 51: 498–502PubMedCrossRefGoogle Scholar
  14. 14.
    Naylor A, Earland C, Robinson J (1983) The effects of diagnostic radiopaque fluids used in discography on chymopapain activity. Spine 8: 875–879PubMedCrossRefGoogle Scholar
  15. 15.
    Nazarian S (1985) Anatomical basis of intervertebral disc puncture with chemonucleolysis. Anat Clin 7: 23–32PubMedCrossRefGoogle Scholar
  16. 16.
    Ray CD (1984) Danger of intravenous injection during chemonucleolysis. J Neurosurg 60: 1327PubMedGoogle Scholar
  17. 17.
    Rocolle J, Degott C, Benoist M. Lassalc B, Nedjar C, Tardivon A, Deburge A (1985) Etude expérimentale de l’action comparée de deux préparation de chymopapaïne sur le disque interverté et de l’effet de l’injection préalable d’un produit de contraste radio-opaque. Rev Chir Orthop 71 [Suppl 2]: 36Google Scholar
  18. 18.
    Smith L, Brown JE (1967) Treatment of lumbar intervertebral disc lesions by direct injection of chymopapain. J Bone Joint Surg [Br] 49: 502–519Google Scholar
  19. 19.
    Troisier O (1980) Traitement des lombosciatiques par injection intra-discale d’enzymes protéolytiques. 80 observations. Nouv Presse Med 9: 227–230Google Scholar
  20. 20.
    Troisier 0 (1982) Technique de la discographie extra-durale. J Radiol 63: 571–578Google Scholar

Copyright information

© Springer-Verlag/Wien 1988

Authors and Affiliations

  • J.-D. Laredo
    • 1
  • J. Busson
    • 1
  • M. Wybier
    • 2
  • M. Bard
    • 1
  1. 1.Department of Bone and Joint RadiologyHôpital LariboisièreParisFrance
  2. 2.Department of Bone and Joint RadiologyHôpital CochinParisFrance

Personalised recommendations