Sciatica caused by disc herniation: Why is Chymopapain Chemonucleolysis denied to our patients?

BACKGROUND: This study was undertaken to assess the long term outcome on the quality of life of patients with sciatica following treatment with chemonucleolysis, and to assess the complications.

METHODS: This is a retrospective review carried out in a consecutive group of patients suffering from sciatica treated by chemonucleolysis. Patients were followed up by questionnaires to obtain Macnab score; satisfaction, SF 36, and case note review for complications and repeat spinal surgery.

RESULTS: Six hundred and five patients (56% males, 44% females) treated over a ten year period from 1991 to 2000 were followed up. Average age was 47 years (range 17 - 88 years). The duration of symptoms prior to treatment averaged 10 months (range 1 - 20 months) and the herniation was confirmed by Myelogram (7%), CT Scan (34%), or MRI (59%). There were 578 single level and 27 double levels treated. Eighty five percent of herniations were typical single level, and 15% were atypical that is: patients with dominant back pain with sciatica, recurrent herniations following surgery at the same level, recurrent herniations at another level following chemonucleolysis, double levels treated patients with mainly neurological deficits and one cauda equina syndrome. Average follow up was 62 months (range 12 - 123) with a 78% satisfaction rate, with a 14% surgical intervention rate made up of 9% decompression, 1% repeat chemonucleolysis at another level and 4% fusion rate. SF-36 scores generally correlated with age and sex on scores for the normal local population.

CONCLUSIONS: This is a retrospective study and showed that chemonucleolysis was effective with a high satisfaction rate. It restores quality of life close to that expected in the population, and is safe with no complications related to the procedure. It is a cost effective daycase procedure with a lasting result.