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Results for “Intervertebral Disc Chemolysis”

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At least 19 recordsLinked to original sources
PubMed1998

Comparative study of surface displacement in discs following chemonucleolysis and lasernucleotomy.

BACKGROUND AND OBJECTIVE: Dynamic changes of the dorsolateral protrusion site have been postulated to play an important role in the therapeutic effect of lasernucleotomy and chemonucleolysis. Basic biomechanical effects of the anulus after lasernucleotomy and chemonucleolysis are investigated. STUDY DESIGN/MATERIALS AND METHODS: This study evaluates the in vitro bulging of lumbar discs comparing lasernucleotomy and chemonucleolysis. The horizontal displacement at the ventral and dorsolateral surface of 20 cadaver discs were tested by application of a continuously increasing axial deformation before and after therapy. The increase in horizontal displacement due to this longitudinal deformation was measured. RESULTS: Bulging was significantly lower at the puncture site of the chemonucleolysis needle as well as at that of the laser trocar. Significantly reduced bulging of the anulus was observed after chemonucleolysis. Slightly increased bulging was observed after lasernucleotomy in the total posterior region. There was a tendency to decreased stiffness after chemonucleolysis and a significantly decreased stiffness after lasernucleotomy. CONCLUSIONS: The in vitro effect of lasernucleotomy seems to be based on reduction of the stiffness by distributing the load all over the anulus, whereas chemonucleolysis reduces bulging.

Biomechanical Phenomena↗
PubMed2000

Surgery for lumbar disc prolapse.

OBJECTIVES: The primary rationale for surgery for disc prolapse is to relieve nerve root irritation or compression due to herniated disc material. Claims of the merits of alternative surgical procedures are made without clear evidence about clinical outcomes. The objective of this review was to assess the effects of surgical interventions for the treatment of lumbar disc prolapse. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, Medline, Embase, Biosis, Dissertation Abstracts, Index to UK Thesis, and reference lists of the retrieved articles up to March 1997 and we corresponded with experts. SELECTION CRITERIA: Randomised and quasi-randomised trials of the surgical management of lumbar disc prolapse. DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data from published papers. Additional information was sought from the authors if necessary. MAIN RESULTS: Twenty-seven trials were found. There were methodological weaknesses in many of the trials. Sixteen of the 27 trials were of some form of chemonucleolysis. Ten trials compared different surgical techniques, although only one of these compared surgical discectomy with conservative management. Surgical discectomy produced better clinical outcomes than chemonucleolysis with chymopapain, and chemonucleolysis produced better clinical outcomes than placebo. Three trials showed no difference in clinical outcomes between microdiscectomy and standard discectomy. Three trials failed to show a significant reduction in scar formation or improved clinical outcomes by inserting an inter-position membra ne to cover the spinal dura after discectomy. Three trials of percutaneous discectomy provided moderate evidence that it produces poorer clinical outcomes than standard discectomy or chymopapain. We found no published randomised trials of laser discectomy. REVIEWER'S CONCLUSIONS: Chemonucleolysis is more effective than placebo and it is less invasive but less effective than surgical disectomy. Surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management, although any positive or negative effects on the lifetime natural history of the underlying disc disease are unclear.

Diskectomy↗
PubMed1989

The effect of chemonucleolysis on serum keratan sulfate levels in humans.

Sensitive measurements of serum keratan sulfate (KS), a glycosaminoglycan found in large quantities in the proteoglycans of human cartilage, can be obtained using an enzyme-linked immunosorbent-inhibition assay. Patients who are undergoing chemonucleolysis (CN) provide a clinical opportunity to monitor the large-scale proteolytic degradation of cartilage. By measuring serum KS levels both pre- and post-CN, we have demonstrated that serum KS levels rise predictably after CN, in a manner that reflects major catabolic events of cartilage.

Adult↗
PubMed2005

Intradiscal injection of oxygen-ozone gas mixture for the treatment of cervical disc herniations.

For disc herniations the use of open surgical approaches is reduced since new percutaneous methods allowing shrinkage of the disc and improvement of the radicular function are gaining interest. Studies on the spontaneous disappearance of disc fragments have demonstrated autoimmune responses with a chronic inflammatory reaction. Also radicular pain has been shown to be mostly due to biochemical mechanisms. Researchers in different fields surprisingly noticed that a brief, calculated, oxidative stress by ozone administration may correct a persistent imbalance due to excessive, chronic oxidative injury. Oxygen-ozone gas injection in painful patients has a dramatic effect on clinical symptoms. On these bases the intradiscal injection of oxygen-ozone gas has been conceived. We report the treatment on a series of patients affected by cervical disc pathology, treated by intradiscal injection of oxygen-ozone gas mixture. The effects both on pain and on radicular dysfunction are impressive. The morphological effect of the treatment was also evaluated by pathological examination.

Adult↗
PubMed2005

Ozone chemonucleolysis in non-contained lumbar disc herniations: a pilot study with 12 months follow-up.

STUDY DESIGN: Prospective case series with six and twelve months follow up. OBJECTIVE: To observe clinical and morphological results of the intradiscal ozone chemionucleolysis in patients affected by non-contained lumbar disc herniations. METHODS: 30 patients were included in the study on the base of precise inclusion and exclusion criteria. The patients were followed on 6 and 12 months period by Visual Analogic Scale (VAS), Roland Morris Disability Questionnaire (RMDQ) and Overall Patient Rating Scale (OPRS). Disc herniation volume morphology was evaluated at 5 months by control MRI scanning. RESULTS: Twenty-seven patients (90%) showed a statistically significant improvement in pain (P < 0.001, Wilcoxon test) and function (P < 0.001, Wilcoxon test), on VAS and RMDQ evaluation, respectively. The mean satisfaction with the treatment on OPSR was 79.3%, with 24 patients referring satisfaction equal or greater than 80%. There were no major complications related to the procedure. CONCLUSIONS: The results of this study indicate the ozone chemonucleolysis as a possibly effective modality of treatment in patients affected by signs and symptoms of non-contained lumbar disc herniations that have overpassed conservative measures and have not yet fulfilled the indications for open surgical treatment.

Adult↗
PubMed2005

The different outcomes of patients with disc herniation treated either by microdiscectomy, or by intradiscal ozone injection.

Disc herniation with radiculopathy and chronic discogenic pain are the result of degenerative processes. Treatment approach in face of this problem has largely been debated in the last years. A number of reviews on surgical treatments in the '80s and '90s have been published and various new techniques have been introduced among which ozone discolysis is one non-invasive intradiscal treatment method. In a 3-year follow-up period we have investigated the different outcomes of 150 patients who received microdiscectomy and 150 patients who received intradiscal ozone injection. In this series results are in favour of discolysis for contained disc herniations and of microdiscectomy for large migrated fragments with pain so severe that open surgery was obligatory. Apart from this, our results with the two techniques are equivalent also concerning mild neurological motor deficits.

Back Pain↗
PubMed1988

Chemonucleolysis or discectomy? Results of a randomized multicentre trial in patients with a herniated lumbar intervertebral disc (a preliminary report).

A randomized trial was carried out to compare the results of discectomy and chemonucleolysis in 151 patients, suffering from lumbar disc herniation L4-L5 or L5-S1. All patients fulfilled strict entry criteria. Seventy eight patients underwent surgical discectomy, 73 were treated with chemonucleolysis. Within one year of follow-up 18 patients (25%) required surgery after chemonucleolysis, whereas 2 patients (3%) in the surgery group underwent re-operation. Increase of radicular pain within 30 days after treatment was encountered in 16 patients (22%) in the chemonucleolysis group, as compared to none in the surgery group. The results of open surgery after preceding chemonucleolysis was successful in 44% and unsuccessful in 56%. The final result of chemonucleolysis, including second treatment, was still slightly less favourable (73%) the result of primary surgery (79%).

Adolescent↗
PubMed1993

[Chemonucleolysis. Its effectiveness in the treatment of lumbar diskopathies caused by compressive or rotational injuries].

One hundred patients who meet McCulloch's indicators for treatment of lumbar disc herniation by chemonucleolysis were entered in this study. Chemonucleolysis in the patients suffering from sciatica secondary to a compression injury, especially with clinical and radiographic evidence of nerve root compression at a single level, can be expected to attain good to excellent results. Chemonucleolysis is far less efficacious in patients suffering from either torsional injury or multiple level abnormality, especially in the absence of neurological deficit. Meticulous attention to patient selection will yield optimal results. The result was excellent or very good in 60% of patients, while in 40% the procedure failed. The rate of success at the L.5/S.1 level was 70%, at the L.4/5 level it was 63% and 37% were successful when multiple levels were treated.

Adult↗
PubMed1989

Quantitative measurement of disc space area before and after chemonucleolysis and nucleotomy.

Measurements of the area of the intervertebral disc space were made, over a period of 400 days or more, in 16 patients who underwent chemonucleolysis and 20 patients after nucleotomy. The superimpositioning method of measurement used is based on a determination of fixed points and it has a high level of reproducibility. We have measured areas which differ from volumes in only a single dimension, but which show good correlation compared with measurement of intervertebral disc space heights alone. After both chemonucleolysis and nucleotomy, narrowing of the intervertebral disc space occurs up to the 50th day, after which there is a highly significant difference: the intervertebral disc space height increases after chemonucleolysis, and continues to decrease after nucleotomy. It is concluded that the enzymatic effect of chymopapain on the nucleus pulposus produces a gain in disc substance after chemonucleolysis, whereas nucleotomy is associated with a loss of substance.

Adolescent↗
PubMed1995

Chemonucleolysis: correlation of results with the size of the herniation and the dimensions of the spinal canal.

The aim of this study was to determine whether the results of chemonucleolysis are related to the size of the disc herniation and to the dimensions of the spinal canal. Short and long-term results (average follow-up 4 and a half years) of 148 patients were evaluated. Measurements made with a divider included the size of the disc herniation related to the sagittal diameter of the spinal canal at the discal level and the transverse interligamentous diameter at the level of the facet joints. The morphology of the lateral recess was also assessed. Measurements were initially made by five observers and were repeated eight times and on eight computed tomography (CT) scans in order to assess intra- and interobserver variability. Measurements of the entire series were then made by the two observers demonstrating a good intra- and interobserver reproducibility. Of the 148 patients 74% had an overall successful result. No significant difference was disclosed when comparing the various parameters of the clinical results with the size of the herniation. Similarly, a lack of correlation was also found between the clinical results and the dimensions of the spinal canal and of the lateral recess. In this series, the results were not significantly influenced by the size of the herniation or the morphology of the spinal canal.

Humans↗
PubMed1995

Magnetic resonance imaging before chemonucleolysis for lumbar disc prolapse.

Chemonucleolysis is an established non-operative treatment of a prolapsed symptomatic lumbar disc. It was introduced as a form of treatment in the early 1960s by Smith [18]. One of the main causes of failure is the difficulty in pre-operative assessment of a contained disc prolapse. Reducing failure rates is very important for the morale of surgeon and patient alike. We investigated 58 patients with magnetic resonance imaging (MRI) to select those with a contained protrusion prior to chemonucleolysis. Per-operative discography confirmed contained protrusion in 96.5% (56/58) of cases, increasing the specificity of selection. At 6 months post chemonucleolysis 86% of our patients were asymptomatic. We would commend MRI as the investigation method of choice prior to chemonucleolysis for a prolapsed symptomatic lumbar disc, thus avoiding separate diagnostic discography, thereby reducing inconvenience to the patient and wastage of prepared chymopapain.

Adult↗
PubMed1990

Automated percutaneous lumbar discectomy with and without chymopapain pretreatment versus non-automated discoscopy-monitored percutaneous lumbar discectomy. An experimental study in human cadaver spines.

Percutaneous lumbar discectomy has gained growing interest during recent years as an alternative to open surgery for protrusions and non-sequestrated subligamentous intervertebral disc herniations. As a less invasive method it competes with chemonucleolysis. At least two modifications are known to date: automated percutaneous lumbar discectomy (APLD) with a 2-mm suction probe and non-automated, discoscopy-monitored percutaneous lumbar discectomy with a suction rongeur and a motor-driven shaver (NAPLD). In this study these two methods are compared for the amount of material extracted, dependence upon the degree of degeneration of the disc and intrinsic technical problems, using 20 human cadaver lumbar specimens for experimental testing. Total nucleotomy was not possible with either method. APLD yielded significantly less material and proved to be less effective in severely degenerated intervertebral discs than the NAPLD procedure, as preexisting gaps within the degenerated nucleus pulposus allowed the tissue to shift away from the tip of the 2-mm probe and facilitated displacement of the probe within the anulus fibrosus. By contrast, the rongeur, which first cuts the material to be removed and then carries it away by suction, was much more effective. Further data to support the advantages of non-automated percutaneous nucleotomy are discussed. Pretreatment of the disc with chymopapain did not result in a higher yield of nucleus material when combined with APLD.

Chymopapain↗
PubMed1997

Efficacy of lumbar discectomy and percutaneous treatments for lumbar disc herniation.

The changing health care environment necessitates careful re-evaluation of all costly elective procedures. Low back surgery is a typical example. This article reviews the current literature addressing the efficacy of surgery and invasive percutaneous treatments for discogenic sciatica. It also discusses the prospects for the continuation of reimbursement for these procedures under a system of managed health care. Relevant articles were identified using the MEDLINE and Current Contents databases, from bibliographies of articles identified from these databases, from recommendations of experts in the field, and from the Canadian Cochrane++ Collaboration. The review includes randomized clinical trials, meta-analyses, published practice guidelines and large case series. The literature is classified and discussed in these quality strata. The review includes 9 randomized trials, 6 meta-analyses or review articles, one evidence-based practice guideline, 38 surgical case series and 35 additional references. Though incomplete, the existing evidence indicates that open discectomy shortens the duration of discogenic sciatica in selected patients. Neurologic outcomes are similar in operated and unoperated patients. Predominant leg pain, evidence of nerve root tension and concordant symptoms and imaging findings, are associated with favorable surgical results. Chemonucleolysis is also associated with more rapid pain relief than conservative treatment, but provides less certain benefit than standard discectomy. Available data on other percutaneous disc treatments do not currently support a statement on efficacy. Various percutaneous techniques are available but there is no solid scientific evidence of efficacy. The benefits of open discectomy, principally reduced duration of pain, appear to justify its use in carefully selected patients when discogenic sciatica fails to improve with conservative measures. Though elective, the procedure will probably continue to be available under managed care, but with increasing scrutiny of operative indications.

Cost-Benefit Analysis↗
PubMed1991

The results of "lumbar disc surgery" following unsuccessful chemonucleolysis.

A group of 100 patients submitted to microsurgical treatment for herniated lumbar disc following unsuccessful chemonucleolysis with chymopapain were retrospectively compared to a statistically comparable group of patients primarily submitted to microsurgery. This comparison demonstrated that previous unsuccessful chemonucleolysis has no influence on either the short-term or the long-term results of subsequent microsurgery.

Adult↗
PubMed1988

Chemonucleolysis for herniated cervical disc.

The authors treated 38 cases with cervical disc prolapse and discoradicular pain by percutaneous chemonucleolysis. Material and procedure are described and the results of 31 cases with a follow-up between 3 and 52 months analysed. The global results were excellent. In detail the results are analysed according to symptomatology, aetiology, findings of discography and the dose of enzyme used.

Adult↗
PubMed1987

Chemonucleolysis of lumbar intervertebral disc prolapse with chymopapain: outcome after 1 year.

One hundred and one consecutive patients with lumbar disc prolapse were treated by chymopapain chemonucleolysis and their response and favourable pre-treatment criteria determined. Most improvement occurred within the first month, and one year after treatment outcome was judged satisfactory (excellent or good) in 71%. Individual patient characteristics associated with a satisfactory response were sciatica of greater severity than back pain (p = 0.005) and duration of symptoms less than 18 months (p = 0.03). Patients fulfilling 3 or 4 of four immediate pre-treatment clinical and radiographic criteria (sciatica more severe than back pain, reduced straight leg raising, neurological deficit, radiographic abnormality) had a satisfactory response more often than others (p less than 0.05). Reported success one year after surgery for disc prolapse is similar. Chemonucleolysis, however, requires less resources and does not preclude subsequent operation. Our results therefore suggest that it might be considered an alternative to surgery when conservative treatment has failed.

Adolescent↗
PubMed1994

Long-term changes in the magnetic resonance image after chemonucleolysis.

After treatment of a symptomatic herniated disc with chymopapain, 14 patients were re-examined by magnetic resonance imaging (MRI) at a mean follow-up of 72 months. Well-defined MRI findings before chemonucleolysis were compared with those after the procedure by an independent observer. Five MRI parameters were assessed. No significant change was noted in the signal intensity of the affected disc, the extent of osteochondrosis and endplate reaction of the affected segment. The height of the affected disc as well as the size of the disc herniation were reduced significantly. The loss of the height is seen as a direct result of chymopapain activity, whereas the alteration of the size of the herniation seems to depend on the natural history of a disc herniation and is probably not a simple result of the treatment.

Adult↗
PubMed2000

[Microsurgery of lumbar disc prolapse. Superior results of microsurgery as compared to standard- and percutaneous procedures (review of literature)].

In a meta-analysis of 69 prospective and retrospective studies, we investigated the value of various surgical techniques in the treatment of lumbar disk herniations. This analysis includes standard diskectomy (5080 patients from nine series), microdiskectomy (5354/23), and comparison of both techniques (2494/10) and furthermore chemonucleolysis (2729/16), laser therapy (881/3), percutaneous nucleotomy (3506/18), comparisons of percutaneous techniques (942/5) with microdiskectomies (561/5) and standard diskectomies (1020/6). Outcomes were rated according to Macnab's criteria: I "excellent", II "good", III "improved", IV "same as before", V "worse", I/II "markedly improved", III "partially improved", IV/V "not improved", I-III "successful", and IV/V "unsuccessful". Results after microdiskectomy were "successful" more often (90% vs. 95%), "good/excellent" more often (82% vs. 73%), and patients left the hospital sooner than with standard diskectomy. Recurrence rates were comparable (4%). Results of both open techniques were clearly superior to those from any type of percutaneous treatment: chemonucleolysis und laser therapy were "successful" in 69% and 70% of cases respectively, with recurrence rates of 17% and 18%, endoscopic nucleotomy was "successful" in 84% of cases, and recurrence rate was 14%. Please ask the author for the reference database.

Diskectomy↗