Treatment Overview
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).
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
Complete the special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.
References
Citations
- Gibson JNA, Waddell G (2007). Surgical interventions
for lumbar disc prolapse. Cochrane Database of Systematic Reviews (2).
Credits
| By | Healthwise Staff |
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| Primary Medical Reviewer | William H. Blahd, Jr., MD, FACEP - Emergency Medicine |
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| Specialist Medical Reviewer | Robert B. Keller, MD - Orthopedics |
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| Last Revised | July 21, 2010 |
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