Low back pain and radiating pain are mainly due to nerve root compression in herniated nucleus pulposus(H.N.P.) and treatment of H.N.P. is determined by several factors.
Recently, many patients can be managed with another conservative treatment, i. e. chemonucleoiysis, without surgical risk if selected properly and prepared to prevent anaphylactic shock.
During past 1.1 years from November 1984 to June 1986, 46 patients with H.N.P. were evaluated and managed with chemonucleolysis in 38 cases excluding 8 cases of rupture types. And following results were obtained with follow up of 6 months over.
1) Of 46 patients, 30 patients(65%) were between 20-30th age group, and male was predominent.
2) The site was most common in L4-5 space (30 patients, 65%).
3) Of 38 patients excluding 8 patients of rupture cases, 30 patients(79%) were excellent and good.
4) As soon as the procedures were performed in 22 cases(good results), radiating pain and neurologic symptoms were disappeared but dull low back and buttock pain were remained in 12 patients (55%) after 6 weeks.
5) The intervertebral disc space narrowing was found from 3rd day on lateral radiograph and this narrowing was noticed above 30% by 1st month.
6) Symptoms were improved in 3 cases among 8 cases of rupture cases in discogram.
7) In , 38 cases, there was no complication except chest tightness and skin prickling - sensation of 8 cases(21%) on whole body there after the injection of chymopapain, but they were soon disappeared.
In summary, chemonucleolysis is indicated in patients with acute onset and predominently radiating pain.
|