Chemonucleolysis Revisited

A Prospective Outcome Study in Symptomatic Lumbar Disc Prolapse

Abstract

Objective 

This prospective study was carried out to assess the functional outcome in patients with symptomatic lumbar disc prolapse treated by chemonucleolysis (CNL).

Methods 

The Oswestry Low Back Pain Disability Index (ODI) was used to assess the pre- and postprocedure functional status of 112 patients with magnetic resonance (MR) scan–proven lumbar disc prolapse treated by CNL. Follow-up was for at least 5 years.

Results 

Ninety-three of 112 patients (83%) had excellent/good results, whereas 11 of 112 (10%) were unchanged and 8 of 112 (7%) were worse after the CNL. The younger patients with single-level discs at L5–S1 had the most successful outcome. Seventy percent of our patients (25–45 years of age) were gainfully employed with a mean return to work at 12 weeks.

Conclusions 

CNL is a good procedure to bridge the gap between conservative treatment and surgery for lumbar disc prolapse. CNL is beneficial in 80% of patients with significant leg symptoms. After careful selection of candidates using MR scans, it is an effective procedure that does not compromise future open surgery, should it be necessary.