CONSERVATIVE TREATMENT: CHEMONUCLEOLYSIS (DISCOLYSIS)

April 1st, 2009 by admin in Healthy bones Osteoporosis Rheumatic

Chemonucleolysis (discolysis)-This is a method of treating a prolapsed disc. It is a chemical alternative to disc surgery, and is used when time and rest have failed to reduce a disc protrusion which is involving a sciatic nerve. It has much the same success rate as surgery, with different but no fewer risks, and perhaps less discomfort and less disablement during the recovery period.

‘Lysis’ means dissolution. In chemonucleolysis, an enzyme called chymopapain is injected into the centre of the damaged disc nucleus. This enzyme is derived from the papaya (pawpaw) fruit (and is used also as a meat tenderiser). It has the effect of dissolving the more complex proteins in the nucleus and in the prolapsed part of the disc. Afterwards, the disc shrinks, becoming perceptibly narrower and stiff er. Because of this reduction in volume, the compression of the nerve is relaxed.

Chemonucleolysis is most successful in young people, and where the disc prolapse is fairly recent and has not had time to cause nerve damage or to produce adhesions. It is least successful in the case of extruded disc material having broken away completely – because the chymopapain cannot reach it.

How it is done-Chemonucleolysis is done under sedation or local anaesthesia; X-rays are used to place the needle accurately through the skin of the back. The orthopaedic surgeon, neurosurgeon or radiologist first injects some contrast medium into the disc to assess the damage; then, with the needle still in place, injects chymopapain. If the treatment is successful, the sciatic pain in the leg goes, sometimes with dramatic rapidity; however, most patients have some backache for a week or two.

There is a considerable risk if the chymopapain is injected in the wrong place, it is a technique only for experts. Even then, there is a small risk of an allergic reaction to chymopapain in patients who have become sensitised to it through eating tenderised meat, or who are allergic to papaya. Drugs are usually administered before the treatment, to minimise the risk of this complication.

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