Chemonucleolysis for Herniated Disc
Chemonucleolysis is the injection of an enzyme into a bulging spinal disc, with the goal of reducing the disc's size. This procedure is done in a hospital or surgical center as an outpatient procedure.
Prior to chemonucleolysis, your doctor checks to see whether a herniated disc is causing your symptoms by using an imaging study, such as magnetic resonance imaging (MRI), computerized tomography (CT scan), or myelogram. During this procedure, a dye may first be injected to find out whether the disc has completely ruptured or is bulging (discography).
If the disc is bulging and has not broken open (ruptured), chemonucleolysis can be considered as a treatment option.
Chemonucleolysis uses an enzyme called chymopapain (derived from papaya), which is injected into the disc space. Local anesthesia or general anesthesia may be used to control pain during the injection. Chymopapain speeds up the breakdown of the jellylike substance inside the disc (nucleus), releasing water. As a result, the bulging disc may shrink and relieve pressure on the nerve root.
This procedure is rarely done.
What To Expect After Treatment
After chemonucleolysis, you may have moderate to severe back pain and spasms lasting from 2 to 3 days or longer after the procedure. You can use prescription medicines to control pain during the recovery period.
For at least 6 weeks, avoid long periods of sitting and repetitive bending, stooping, and lifting.
Depending upon your individual condition and work requirements, it may take weeks or months for you to return to your normal activities.
Why It Is Done
Chemonucleolysis has been tried as a way to relieve symptoms without having surgery. Decreasing the size of the disc through chemonucleolysis may take the pressure off nerve roots and lead to reduced symptoms.
This procedure may be done when the following conditions are met:
Sometimes chemonucleolysis is done when there are signs of serious nerve damage (that may be getting worse) in the leg. These can include severe weakness, loss of coordination, or loss of feeling. But most doctors would be more likely to do surgery to remove the disc (discectomy) if symptoms are this severe.
How Well It Works
Research shows that chemonucleolysis can be an effective treatment for carefully selected herniated disc problems. But it is less effective than standard discectomy and may lead to a need for further treatment, which may include surgery.1
Risks of this surgery include:
What To Think About
Discectomy (or microdiscectomy) is more effective than chemonucleolysis and has fewer potential side effects.1
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