Chemonucleolysis

This is a technique in which a protein digesting enzyme (chymopapain) is injected into the central disc space and allowed to actually digest the disc material. It is reserved for patients with a documented herniated disc that have failed at conservative therapy. It fell out of favor a number of years ago, and probably for good reason, since more than 50% of patients experience increased back pain and muscle spasm after the injection and nearly 80 percent have incapacitating back pain for up to three months after treatment.(1) However, 70-80% of patients have a resolution of radicular pain within six weeks of injection.(2) Although considered a legitimate therapy, I am a little leery of someone injecting an enzyme capable of indiscriminately dissolving human tissue anywhere close to my spinal nervous system. If it is injected into the wrong place, it can digest the wrong structure. Once the enzyme solution is injected, it cannot be taken back. It is very difficult to insure that there is no breach in the disc capsule that would allow the solution to enter the spinal canal or contact nerve tissue. In that event, a digestion of the nerve roots or other elements could occur. The person doing the procedure has to be skillful and accurate every time. Allergies to the enzyme have also been known to result in anaphylactic (severe allergic) reactions.

An additional thought is that, over the long term, even a poorly functional disc is better than no disc. Without the disc, the vertebral bones would rub together or shift due to the lack of support inherent in the concentric structure. In the case of a posteriorly damaged disc, one still has the anterior component to provide some shock-absorbtion. There is little ability once the chemical is injected to differentiate good disc material from bad disc material. Everything is digested the same. For this reason, I really cannot recommend the therapy. In fact, I am not knowledgeable of a physician who performs this in my area; and I have practiced medicine for 15 years without making a single referral for this modality. Moreover, I have never attended upon a patient who has had the procedure. Therefore, I would say be very careful if this option is considered and become fully-informed prior to your decision.

Further Reading

Introduction
TENS (Transcutaneous Electrucal Nerve Stimulation)
Ice and Heat
Acupuncture
Trigger Point Point Injections
Epidural Steroid / Aneshetic Injections
Chemonucleolysis
Surgery
Percutaneous Diskectomy
Microdiskectomy
Laminectomy
Artificial Discs
Fusion

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