Enzyme Dissolution of the Nucleus Pulposus

Smith, Lyman; Garvin, Paul J.; Gesler, R. M.; Jennings, Robert B.

doi:10.1038/1981311a0

Cited by 149 publications

(42 citation statements)

References 4 publications

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“…Based on these findings, MMP-7 shows great promise as a candidate for the clinical treatment of herniated discs. Chemonucleolysis has been described classically as enzymatic dissolution of the nucleus pulposus of the intervertebral disc [23]. Chemonucleolysis represents a minimally invasive, intermediate therapeutic option between conservative management and surgery [5].…”

Section: Mmp-7mentioning

confidence: 99%

Experimental studies on the effects of recombinant human matrix metalloproteinases on herniated disc tissues—how to facilitate the natural resorption process of herniated discs

Haro

Komori

Kato

et al. 2005

Journal Orthopaedic Research

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Purpose. Recently, MMP-7 and MMP-3 have been found to play a crucial role in the natural resorption process of herniated discs. We therefore examined the role of these recombinant human matrix metalloproteinases (rh MMPs) in the treatment of herniated discs.Methods. (a) Surgical samples of herniated disc were cultured in the presence or absence of rh MMPs, and wet weight was measured 24h later. (b) The rh MMPs were administered into normal rabbit intervertebral discs, and after 1 week spine samples were stained with Safranin 0. (c) The rh MMPs were administered into canine herniated discs in vivo. Myelography and MRI were performed prior to and 1 week after administration. Spine samples were examined histologically. Whole disc tissue was collected, total protein was extracted, and Western blot analysis was performed.Results. (a) Proteoglycan degradation was found in MMP-7, MMP-3, and chymopapain-treated samples. MMP-7 and chymopapain-treated samples displayed a significant loss in wet weight 0, < 0.01). (b) Normal disc tissues after administration of rh MMP-7, MMP-3, and chymopapain showed an extensive loss of Safranin 0 staining. (c) The rh MMP-7-treated discs had a marked decrease in protruded herniation by MRI. Herniated discs after administration of MMP-7 and chymopapain showed a significant decrease in protruded mass 7 days after administration compared with saline-treated discs when evaluated by myelography (p < 0.01). The rh MMP-7-treated discs displayed a clear loss of Safranin 0 staining in the nucleus pulposus. Proteoglycan expression was barely detectable in disc tissues after MMP-7 administration, whereas obvious expression was obtained in saline-treated or untreated disc tissues.ConrIusions. Exposure to rh MMP-7 resulted in promising proteoglycan loss in human surgical samples, normal rabbit intervertebral discs, and natural canine herniated discs. Administration of rh MMP-7 may facilitate the resorption process of herniated discs.

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Section: Mmp-7mentioning

confidence: 99%

Experimental studies on the effects of recombinant human matrix metalloproteinases on herniated disc tissues—how to facilitate the natural resorption process of herniated discs

Haro

Komori

Kato

et al. 2005

Journal Orthopaedic Research

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“…In the last 40 years many investigators have attempted to find alternatives to laminectomy and discectomy, including evacuation of nuclear tissue via an anterior retroperitoneal approach,[9] chemonucleolysis, [52] or laser nuclear ablation. [2,4,14] As early as 1973, mechanical nucleotomy using Craig Instrumentation was attempted at the Graduate Hospital in Philadelphia.…”

Section: Herniated Lumbar Discmentioning

confidence: 99%

“…[18,34] Controversy remains unresolved regarding the indications for stabilizing lumbar motion segments and whether posterolateral intertransverse fusion alone provides pain relief or adequate stabilization. [3,31,[50][51][52][53][54] Certainly the broad surface of the vertebral plates, adequacy of the blood supply, and natural exposure of the fusion site to compression forces provide a sound basis that favors vertebral interbody arthrodesis. In addition to this, when an internal disc disruption is the primary cause of symptoms, discectomy and stabilization of the anterior column appear to be the treatment of choice.…”

Section: Unstable Lumbar Motion Segmentsmentioning

confidence: 99%

Minimally invasive techniques in spinal surgery: current practice

Kambin

Gennarelli²,

Hermantin³

1998

FOC

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Minimally invasive spinal surgery under arthroscopic or endoscopic magnification and illumination is emerging as an alternative, reliable method of treatment in a variety of spinal disorders. The operative techniques being used for discectomy and retrieval of herniated disc fragments or stabilization of unstable spinal motion segments are being utilized for visual diagnosis and debridement of infectious discitis and osteomyelitis transpedicular and transforaminal vertebral body biopsy, temporary diagnostic fixation of unstable lumbar motion segments, and transforaminal epidural steroid therapy.

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“…4 Alternative techniques have been developed and tested, and chemonucleolysis, which refers to the use of chymopapain for enzymatic lysis of the nucleus disc, has been among the most relevant. This technique was first described by Smith in 1964 5 and is the least invasive technique for lumbar disc herniation, presenting lower rates of complications in comparison with discectomy. 6 According to some authors, fewer days in the hospital was found for patients treated with chemonucleolysis, when compared to traditional surgery, 7,8 which augmented the considerable cost savings.…”

Section: Introductionmentioning

confidence: 99%

Chemonucleolysis in Lumbar Disc Herniation: A Meta-Analysis

Couto

Castilho

Menezes

2007

Clinics

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Couto JMC, Castilho EA de, Menezes PR. Chemonucleolysis in lumbar disc herniation: a meta-analysis. Clinics. 2007;62(2):175-80. PURPOSE:To carry out a systematic review and meta-analysis of the efficacy of chemonucleolysis in the treatment of lumbar disc herniation. METHODS: Clinical trials were selected from 3 electronic databases (The Cochrane Controlled Trials Register, MEDLINE, and EMBASE). Data were analyzed with the software STATA, using the meta command. RESULTS: Twenty-two clinical trials were eligible. For chemonucleolysis versus placebo, the summary risk ratio estimate for pain relief as outcome was 1.51 (95% CI: 1.27-1.80). The summary estimate was 1.07 (95% CI: 0.95-1.20) for the comparison between chymopapain and collagenase. Regarding chemonucleolysis with chymopapain versus surgery, the fixed-effect summary estimate of effect for pain relief was 0.93 (95% CI: 0.88-0.98) with surgery as the reference group. In this case, heterogeneity was statistically significant. CONCLUSIONS: Chemonucleolysis with chymopapain was superior to placebo and was as effective as collagenase in the treatment of lumbar disc prolapse. Results for studies comparing chemonucleolysis with surgery were heterogeneous, making it difficult to interpret the summary measure of effect. KEYWORDS:Chemonucleolysis. Chymopapain. Systematic review. Meta-analysis. Lumbar disc herniation. INTRODUCTIONSurgery to treat lumbar disc prolapse was introduced in 1934, 1 and ever since it has been considered as the main treatment modality when conservative treatment has failed. However, the therapeutic efficacy of surgical intervention has been a concern, considering that 20% of the patients are still in pain after surgery, 3 and that 7% to 15% of the patients undergoing discectomy develop the syndrome of failure of the lumbar surgery. 4 Alternative techniques have been developed and tested, and chemonucleolysis, which refers to the use of chymopapain for enzymatic lysis of the nucleus disc, has been among the most relevant. This technique was first described by Smith in 1964 5 and is the least invasive technique for lumbar disc herniation, presenting lower rates of complications in comparison with discectomy. 6 According to some authors, fewer days in the hospital was found for patients treated with chemonucleolysis, when compared to traditional surgery, 7,8 which augmented the considerable cost savings. [9][10][11][12] In a prospective study with a follow-up of at least 5 years, among 112 patients treated by chemonucleolysis, 83% had excellent/good results, 10% were unchanged, and 8% were worse after chemonucleolysis. 13 Nevertheless, an increased global cost was observed if a conventional surgery was needed following failure to improve after an initial chemonucleolysis.14 Some studies have shown superior efficacy of chemonucleolysis with chymopapain, as compared with placebo, 15-17 but there are conflicting results. 18 In a systematic review of surgical procedures for lumbar disc prolapse that included studies published until 1999, discecto...

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Enzyme Dissolution of the Nucleus Pulposus

Cited by 149 publications

References 4 publications

Experimental studies on the effects of recombinant human matrix metalloproteinases on herniated disc tissues—how to facilitate the natural resorption process of herniated discs

Experimental studies on the effects of recombinant human matrix metalloproteinases on herniated disc tissues—how to facilitate the natural resorption process of herniated discs

Minimally invasive techniques in spinal surgery: current practice

Chemonucleolysis in Lumbar Disc Herniation: A Meta-Analysis

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