Chemonucleolysis for Herniated Disc
Chemonucleolysis is the injection of an enzyme into a bulging spinal disc, with the goal of reducing the disc's size. This procedure is done in a hospital or surgical center as an outpatient procedure.
Prior to chemonucleolysis, your doctor checks to see whether a herniated disc is causing your symptoms by using an imaging study, such as magnetic resonance imaging (MRI), computerized tomography (CT scan), or myelogram. During this procedure, a dye may first be injected to find out whether the disc has completely ruptured or is bulging (discography).
What Kind of Back Problem Do You Have?
Unless you are totally immobilized from a back injury, your doctor probably will examine your range of motion and nerve function and touch your body to locate the area of discomfort. Blood and urine tests may be done to determine if the pain is due to an infection or other systemic problem. X-rays are useful in pinpointing broken bones or other skeletal defects. They can sometimes help locate problems in connective tissue. To analyze soft-tissue damage, computed tomography (CT) or magnetic...
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If the disc is bulging and has not broken open (ruptured), chemonucleolysis can be considered as a treatment option.
Chemonucleolysis uses an enzyme called chymopapain (derived from papaya), which is injected into the disc space. Local anesthesia or general anesthesia may be used to control pain during the injection. Chymopapain speeds up the breakdown of the jellylike substance inside the disc (nucleus), releasing water. As a result, the bulging disc may shrink and relieve pressure on the nerve root.
This procedure is rarely done.
What To Expect After Treatment
After chemonucleolysis, you may have moderate to severe back pain and spasms lasting from 2 to 3 days or longer after the procedure. You can use prescription medicines to control pain during the recovery period.
For at least 6 weeks, avoid long periods of sitting and repetitive bending, stooping, and lifting.
Depending upon your individual condition and work requirements, it may take weeks or months for you to return to your normal activities.
Why It Is Done
Chemonucleolysis has been tried as a way to relieve symptoms without having surgery. Decreasing the size of the disc through chemonucleolysis may take the pressure off nerve roots and lead to reduced symptoms.
This procedure may be done when the following conditions are met:
- Your history, physical exam, and diagnostic imaging (such as MRI, CT scan, or myelogram) indicate that the disc is bulging, but the material inside the disc (nucleus) has not ruptured into the spinal canal.
- Pain and nerve damage have not improved after at least 4 weeks of nonsurgical treatment.
- Your symptoms are severe and disabling.
- You are not able or willing to have surgery.
Sometimes chemonucleolysis is done when there are signs of serious nerve damage (that may be getting worse) in the leg. These can include severe weakness, loss of coordination, or loss of feeling. But most doctors would be more likely to do surgery to remove the disc (discectomy) if symptoms are this severe.
How Well It Works
Research shows that chemonucleolysis can be an effective treatment for carefully selected herniated disc problems. But it is less effective than standard discectomy and may lead to a need for further treatment, which may include surgery.1
Risks
Risks of this surgery include:
- An allergic reaction to the enzyme or the dye used to see the disc. This can range from a simple rash with itching and localized swelling to a life-threatening reaction that leads to difficult breathing and shock (anaphylaxis). (These reactions are now rare since doctors began testing patients for allergic reactions by using a simple skin test.)
- Increased back pain and muscle spasms after the injection.
- For many people, severe back pain that may limit daily activities for up to 3 months after treatment.
What To Think About
Discectomy (or microdiscectomy) is more effective than chemonucleolysis and has fewer potential side effects.1
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