If correct indications and rigorous technique are applied, nucleolysis with chymopapain can be an effective cure for herniated nucleus pulposus in patients who do not respond to adequate medical treatment. Pain relief is obtained in approximately 75% of the patients. In case of failure, secondary surgery may be proposed with a success rate similar to primary surgery. The risk of complications is lower than for surgery. Initial satisfactory results are usually maintained at long term. The main inconveniences include a possible painful reaction in 30-40% of the patients and in certain cases progressives rather than rapid pain relief. Cost analysis shows a 40% gain over surgery. After 20 years of experience, chemonucleolysis for herniated nucleus pulposus has been shown to be an effective therapeutic technique which should be part of an overall management strategy including medical treatment and surgery.

Chymopapain↗

PubMedDate not supplied

[Primary biliary cirrhosis associated with rheumatoid arthritis and acute polymyositis].

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Acute Disease↗

PubMedDate not supplied

[Arthrotic sciatica caused by radicular compression of osteophytic origin in the lateral recess. Apropos of 18 cases].

The authors report 18 cases of arthrosic sciatica due to toot compression in the lateral recess by posterior corporeal and/or posterior apophyseal osteophytosis. The authors study the clinical and radiological characteristics that may indicate the diagnosis and discuss the different mechanisms by which vertebral arthrosis can lead to radicular compression. When surgery is necessary because of the persistent nature of the sciatica, a broader approach should be undertaken than that required for excision of the disc, in order to explore fully the roots, the multiplicity of possible compression sites being one of the essential characteristics of these cases of arthrosic radiculopathy. Study of the literature and of the series of sciatica patients operated upon by the authors shows that although discal hernia is far from being the most frequent cause of common sciatica, arthrosic compression is a cause that cannot be ignored, especially in aged subjects.

Female↗