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Chemonuoleolysis: The Relationship of the Physical Findings, Discography, and Myelography to the Clinical Result

Fifty consecutive patients undergoing chemonucleolysis with chymopapain at William Beaumont Hospital were analyzed with special reference to the following factors: 1) the physical examination, 2) the dye pattern noted on discogram, and 3) the size of the preoperative myelographic defect. Discogram pattern was divided in four types: 1) normal disc, 2) degenerative pattern, 3) degenerative pattern with extravasation, and 4) annular injection. The myelograms were graded into a mild defect, a moderate defect, or a severe defect. Follow-up averaged 20 months. Conclusions of this study were 1) Chymopapain can be considered as an alternative to lumbar laminectomy for relief of sciatica secondary to herniated disc. 2) Statistically significant improved postinjection results were noted when patients presented with three out of four objective physical findings consisting of positive straight leg raising, reflex change, dermatomal paresthesia pattern, and/or mild motor weakness. 3) Placement of the needle within the nucleus leads to a statistically significant improved result over placement of the needle into the annulus. 4) A severe myelographic defect greater than 50% dura sac compression is a relative contraindication to the injection of chymopapain.