The intradiscal injection of chymopapain has been performed for the treatment of cervical disc herniation in 86 patients since 1984. C1 C2 puncture myelography and CT myelography were prefered for the adjuncts. A discography preceded enzyme injection to observe whereabouts of intradically injected substances.
Technique: The 21-gauge spinal puncture needle is introduced anterolaterally into the disc space with the aid of the fluoroscopic image intensifier. Care should be taken not to injure the vertebral endplate. Urografin-60 is injected in the amount of less than 0.5ml. Although some leak of the dye is found at the anterior and posterior parts of the annulus, one ml (2.5 nKat) of chymopapain injection can be carried out.
Following results were obtained.
1) Follow-up of 86 cases showed excellent in 36 cases (41.9%), good in 38 cases (44.270), fair in 8 cases (9.3%), unchanged in three cases (3.5%), and worse in one case (1.2%), respectively.
2) There are good results in chemonucleolysis on three interspaces as well as one or two interspaces.
3) The cervical CT myelography is preferable to other diagnostic studies for evaluation of herniated cervical disc.
4) The postinjection-spinal-instability developed in 69 (80.2%) of the 86 cases for there to four days but it disappeared within a week.
5) In discography, there were contrast medium leakage to epidural, anterior and posterior interspaces in 25 cases (29.1%) of patients but were not related with the outcome of the chemonucleolysis.
6) 79 cases (91.9%) showed the narrowing of the intervertebral disc space within three months after chemonucleolysis.
7) No serious complication such as anaphylaxis or immediate profound hypotension was observed.
In conclusion, cervical chemonucleolysis with chymopapain is demonstrated to be an effective treatment of cervical disc herniation.
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