Five-Year Results From Chemonucleolysis With Chymopapain or Collagenase

Wittenberg, R. H.; Oppel, Sabine; Rubenthaler, F.; Steffen, R.

doi:10.1097/00007632-200109010-00002

Cited by 43 publications

(28 citation statements)

References 56 publications

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“…Purified bacterial collagenase, derived from Clostridium histolyticum , has also been used for chemonucleolysis. A prospective randomized study using chymopapain and collagenase showed good and excellent outcomes 5 years after treatment in 72 % of the chymopapain group and in 52 % of the collagenase group [42]. In addition, a prospective randomized trial of 100 consecutive lumbar HD patients was performed to determine whether chemonucleolysis with chymopapain or standard discectomy showed better or improved outcomes.…”

Section: Development Of a Less Invasive Treatment For Hdmentioning

confidence: 99%

Translational research of herniated discs: current status of diagnosis and treatment

Haro

2014

Journal of Orthopaedic Science

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Lumbar herniated discs commonly occur in patients 20–40 years of age, and result in acute symptoms of shooting and intractable pain in the low back and/or lower extremities. However, the prognosis of these patients is considered to be very good. Moreover, 70 % of these patients have been reported to be free from sciatica at approximately 6 months after the first onset. Magnetic resonance imaging (MRI) studies have described the spontaneous resorption process of herniated discs, which is a major cause of the reduction of symptoms in patients. New advancements in MRI have recently been developed that have facilitated the examination of nerve tract fibers and identification of symptomatic nerve tissue. Furthermore, the mechanism underlying the resorption process of a herniated disc has been determined. Inflammatory cytokines such as TNF (tumor necrosis factor)-α, angiogenic factors such as vascular endothelial growth factor, and enzymes such as matrix metalloproteinases are intricately related to each other. In our previous studies, matrix metalloproteinase-7 (MMP-7) has been shown to play a crucial role in the initiation of herniated disc resorption. Therefore, we developed recombinant human MMP-7 for intradiscal therapy through an industry–university joint research program. We have already performed in vitro and in vivo experiments to confirm its efficacy; this therapy avoids the side effects associated with surgery, such as nerve tissue damage. Moreover, the phase 1/2 studies of recombinant human (rh) MMP-7 are currently ongoing in the United States, and careful monitoring is required for these clinical trials. In conclusion, patients with lumbar herniated discs may benefit from the development of a less invasive treatment for disc herniation, which can be applied even immediately after the onset of disease symptoms.

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Section: Development Of a Less Invasive Treatment For Hdmentioning

confidence: 99%

Translational research of herniated discs: current status of diagnosis and treatment

Haro

2014

Journal of Orthopaedic Science

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“…46 One further study 61 did not report any global effect, pain intensity or CSOM data. 61 Three studies compared different types of chemonucleolysis [211][212][213] and one study 213 included three intervention arms.The types of chemonucleolysis being compared are listed in Table 31b, but the findings of these studies are not considered any further than this.…”

Section: Summary Of Overall Findings For Epidural/intradiscal Injectimentioning

confidence: 99%

“…47,48,51,56,205 However, these were experienced by only one or two participants within each study (that compared chemonucleolysis with another types of treatment). One study 211 that compared two types of chemonucleolysis (with 5 years' follow-up data) reported slightly higher levels of serious adverse effects. When combining data from both treatment arms (n = 50), 12 participants experienced severe pain and 11 experienced neurological deficit.…”

Section: Analysis Of Adverse Effects For Chemonucleolysismentioning

confidence: 99%

The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model

Lewis

Williams²,

Matar³

et al. 2011

Health Technol Assess

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How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTAThe clinical effectiveness and costeffectiveness of management strategies for sciatica: systematic review and economic model NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA pro...

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“…Studies had documented the effect of epidural steroids in the symptomatic of disc prolapsed as early as 1952 when hydrocortisone was used by Robecchi and Capra. [14] The rationale for anti-inflammatory treatment with preganglionic steroid infiltration in the relief of the preganglionic inflammation by ensuring recovery of the normal ganglioneural myelin sheath, and hence nerve function at the disease site, [15,16] and is an effective tool for the relief of root pain caused by spondylosis or disk herniation, but the effects appear to be short lived. [17,18] The success rates with epidural steroid injection vary in literature but most studies report a good success rate in short term while the average success rate at 6 months has been 30-49%.…”

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of Caudal Epidural Steroid Injections in Managing Lumbar Disc Prolapse

Borgohain¹,

Gogoi²

2015

jemds

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Lumber disc prolapse as a cause of back and leg pain is quite a common presentation at a pain clinic which results in significant disability & overall loss of productive work. This study is an uncontrolled, prospective study that included 25 patients (15 males and 10 females) during the period 2013-2014 with signs and symptoms of back pain associated with lumber disc prolapsed with lumbar radiculopathy, in whom conservative treatment of least 6 weeks had failed. The present study was undertaken with the aim to observe the effectiveness of caudal epidural injection of a combination of depomedrol (Methyl prednisolone acetate) along with a local anesthetic (0.5% bupivacaine) in relieving symptoms of lumbar disc prolapse with radiculopathy. Quantitative assessment was done for back pain & leg pain separately using the visual analogue scale and the functional disability was measured using oswestry disability index (ODI) before the procedure and at regular intervals after the procedure for a period of 6 months. All the patients had an ODI more than 40% before the procedure. At 24 hours, significant pain relief was seen in all the patients. After 3 weeks, symptomatic improvement was seen in 100.0% (25/25 patients) of the cases, with good results in 68.0% (17/25, ODI 0-20%) and fair result (ODI 20-40%) in 32.0% (8/25 patients). At 6 months follow up, 60.0% (15 patients/25) of patients showed functional improvement of which with good results were seen in 52.0% (13/25) and fair result in 8.0% (2/25) and poor results in 40.0% (10/25). None of the patients had any major complications. Thus, it can be concluded that caudal epidural steroid injections are one of the safe and effective modality of treatment in back pain associated with lumbar disc prolapse with good short term results and possibly long term in some patients.

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Five-Year Results From Chemonucleolysis With Chymopapain or Collagenase

Abstract: After 5 years, no deterioration had occurred, as compared with the 1-year follow-up assessment. Chymopapain has proved to be safe, with one minor anaphylactic reaction, and effective even over the long term. Collagenase may need further study and cannot be recommended at this time.

Cited by 43 publications

References 56 publications

Translational research of herniated discs: current status of diagnosis and treatment

Translational research of herniated discs: current status of diagnosis and treatment

The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model

Clinical Evaluation of Caudal Epidural Steroid Injections in Managing Lumbar Disc Prolapse

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