Enzyme Dissolution of the Nucleus Pulposus in Humans

Smith, Lyman

doi:10.1001/jama.1964.03060150061016

Cited by 335 publications

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“…Chemonucleolysis, consisting of intradiskal chymopapain injection, available since 1964 [31], demonstrated long-term success rates between 66% and 88%. Unfortunately, chymopapain had the potential risk of paralysis secondary to transverse myelitis and an anaphylaxis rate estimated at 0.3-0.5%.…”

Section: Discussionmentioning

confidence: 99%

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Nucleoplasty in the Treatment of Lumbar Diskogenic Back Pain: One Year Follow-Up

Masala

Massari

Fabiano

et al. 2007

Cardiovasc Intervent Radiol

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Purpose: The spine is an important source of pain and disability, affecting two thirds of adults at some time in their lives. Treatment in these patients is mainly conservative medical management, based on medication, physical therapy, behavioral management, and psychotherapy, surgery being limited to elective cases with neurologic deficits. This study was carried out to evaluate the efficacy of percutaneous nucleoplasty in patients affected by painful diskal protrusions and contained herniations. Methods: From February 2004 to October 2005, 72 patients (48 men, 24 women; mean age 48 years) affected by lumbar disk herniation were treated with nucleoplasty coblation. All patients were evaluated clinically and with radiography and MRI in order to confirm the presence of lumbalgic and/or sciatalgic pain, in the absence of major neurologic deficit and with lack of response after 6 weeks of conservative management. Results: Average preprocedural pain level for all patients was 8.2 (on a visual analog scale of 1 to 10), while the average pain level at 12 months follow-up was 4.1. At the 1 year evaluation, 79% of patients demonstrated a statistically significant improvement in numeric pain scores (p < 0.01): 17% (12 patients) were completely satisfied with complete resolution of symptoms, and 62% (43 patients) obtained a good result. Conclusion: Our data indicate that nucleoplasty coblation is a promising treatment option for patients with symptomatic disk protrusion and herniation who present with lumbalgic and/or sciatalgic pain, have failed conservative therapies, and are not considered candidates for open surgery.Key words: Diskogenic back pain-Interventional radiology-Lumbar pain-Nucleoplasty-SpineThe spine is an important source of pain, suffering, and disability, affecting two thirds of adults at some time in their lives [1,2]. In these individuals the treatment remains mainly conservative, including medication, physical therapy, behavioral management, and psychotherapy.In recent years the general trend in spinal surgery has been toward reduction and minimalization. In fact minimally invasive techniques for the treatment of degenerative pathology of the spine have come to be preferred by surgeons since the destructive effect on bony structures is eliminated and scar formation is greatly reduced [3]. Nucleoplasty is new minimally invasive therapeutic option that has been used for spinal procedures since July 2000.The following study was carried out to evaluate the efficacy of nucleoplasty, performed under local anesthesia, in patients affected by diskal protrusions and contained herniations. Materials and MethodsFrom February 2004 to October 2005, a total of 72 patients (48 men, 24 women; age range 32-64 years, mean 48 years) affected by lumbar diskal protrusions and contained herniations were treated with percutaneous nucleoplasty. All patients were evaluated by radiography and MRI in order to confirm the presence of contained disk herniation.Patients had to satisfy specific inclusion and exclusion crite...

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Section: Discussionmentioning

confidence: 99%

“…Unfortunately, chymopapain had the potential risk of paralysis secondary to transverse myelitis and an anaphylaxis rate estimated at 0.3-0.5%. These risks far outweighed the potential benefit of this procedure [31].…”

Section: Discussionmentioning

confidence: 99%

Nucleoplasty in the Treatment of Lumbar Diskogenic Back Pain: One Year Follow-Up

Masala

Massari

Fabiano

et al. 2007

Cardiovasc Intervent Radiol

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“…The conservative methods include (1) bed rest (2) anti-inflammatory drugs (3) various forms of physiotherapy (4) manipulation and exercise training (5) corsets (6) epidural nerve…”

Section: Introductionmentioning

confidence: 99%

Functional Outcome of Intervertebral Disc Prolapse Treated with Epidural Steroid and Local Anaesthetic – Prospective Study

CV¹

2017

JMSCR

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confidence: 99%

Intradiscal pressure after repeat intradiscal injection of hypertonic saline: an experimental study

2001

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IntroductionChemonucleolysis with chymopapain, which was first clinically used by Smith [12], is an effective treatment for intervertebral disc herniation. However, anaphylactic reactions, in particular, have limited the use of this treatment. To prevent anaphylactic reactions, skin testing and the use of H1 and H2 blocking agents have been recommended. Anaphylactic reactions to chymopapain have decreased in frequency over the years [5]. However, the risk of anaphylaxis still remains. Accordingly, an alternative substance for chemonucleolysis has been sought.Proteoglycans are major structural components of the intervertebral disc, and their concentration and organization in the extracellular matrix have a considerable influence on its mechanical properties. Bayliss et al. [2] described a reduction in proteoglycan synthesis rates when disc hydration was decreased.Shioda [11] suggested a mechanism for a decrease in the intradiscal pressure after hypertonic saline injection, by which partial cell necrosis leads to a decrease in matrix production. Released lysosomal enzymes from the cells could then cause partial proteolysis. As a result, the amount of proteoglycan decreases, which means the water-binding capacity decreases. He suggested that the direct effect of hypertonic saline on the matrix was minimal.We have previously reported intradiscal pressure after intradiscal injection of hypertonic saline in rabbits, but the results of the study found that hypertonic saline injected Abstract Chemonucleolysis with chymopapain is an effective alternative to an operation for the treatment of some patients who have a lumbar intervertebral disc herniation. However, chymopapain is associated with rare but serious complications. Accordingly, alternative substances for chemonucleolysis have been sought. The main beneficial effect of chemonucleolysis derives from the decrease in the intradiscal pressure. We have previously reported that hypertonic saline injected into the intervertebral discs decreased the intradiscal pressure, but only temporarily. The present experimental study investigated changes in the intradiscal pressure after a repeat intradiscal injection of hypertonic saline. The lumbar intervertebral discs of 18 living rabbits were examined: 10% hypertonic saline was injected intradiscally just once in 12 rabbits, and the same dosage was injected again, 4 weeks later, in the same animals. The intradiscal pressure was measured at 1, 4, 8, and 12 weeks after the second injection. The remaining six rabbits were used as controls, without puncture and without injection. The intradiscal pressure of the group with repeat hypertonic saline injection at 4 weeks was significantly lower than that of the control group. The decreased pressure showed a tendency to increase at 8 weeks, and it had recovered at 12 weeks. The results of this study suggest that repeat hypertonic saline injections may be clinically useful.

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Enzyme Dissolution of the Nucleus Pulposus in Humans

Cited by 335 publications

References 0 publications

Nucleoplasty in the Treatment of Lumbar Diskogenic Back Pain: One Year Follow-Up

Nucleoplasty in the Treatment of Lumbar Diskogenic Back Pain: One Year Follow-Up

Functional Outcome of Intervertebral Disc Prolapse Treated with Epidural Steroid and Local Anaesthetic – Prospective Study

Intradiscal pressure after repeat intradiscal injection of hypertonic saline: an experimental study

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