Lumbar CT Findings and Results of Chemonucleolysis

ABSTRACT

The therapeutic response to treatment of lumbar disk heniation with chymopapain chemonucleolysis is significantly influenced by the criteria used for patient selection. In an attempt to identify objective pretreatment radiographic findings, especially spine CT scanning, that might refine selection criteria and further increase to success rate of chemonucleolysis, a retrospective correlation of pretreatment spine CT findings and clinical results easmade of 1000 consecutive patients from May 1984 to September 1987 at the Dept. of Neurosurgery, Yongdong Severance Hospital, Yonsei University College of Medicine. The data were obtained from a questionnare and clinical records. Overall success rate was 87.5%. The favorable CT parameters to define the higher successful rate of chemonucleolysis included:1) single level treatment;2) posterolateral directed herniation;3) mild to moderate degree protrusion;4) protruded type herniation;5) not combined facet hypertrophy or sipinal stenosis. The unfavorable CT parameters placed into lower successful rate of chemonucleolysis included:1) multiple levels treatment;2) degenerative bulging annulus;3) severe degree protrusion;4) sequestered type herniation;5) combined degenerative spondylosis or facet hypertrophy of spinal stenosis, bony spur or calcification of disc.