A 1- to 4-year follow-up review of treatment of sciatica using chemonucleolysis or laminectomy

Abstract

To help clarify the comparative effects of chemonucleolysis and discectomy, the author studied 178 consecutive patients with sciatica who did not respond to conservative treatment. None had previously undergone laminectomy or chemonucleolysis or had spinal stenosis. All received postmyelography computerized tomography (CT) and, if the radiological interpretation was that of an extruded migrated disc, a laminectomy was performed; otherwise, the patient was given a choice of the two procedures. Of the 178 patients, 106 underwent chemonucleolysis and 72 laminectomy. Workers' compensation was being paid to 21.6% of the chemonucleolysis patients and 20.8% of the laminectomy patients. Postoperatively, substantial improvement was noted in 82.7% of the chemonucleolysis patients and 92.5% of the laminectomy patients at 6 weeks and in 92.8% of the chemonucleolysis patients and 89.7% of the laminectomy patients at 6 months. The majority of patients in both groups had improved neurological signs. Follow-up questionnaires at 1 to 4 years postoperatively revealed an overall success rate of 86.5% for chemonucleolysis patients and 83.8% for laminectomy patients. In patients not receiving workers' compensation, 90.1% of the chemonucleolysis patients and 88.6% of the laminectomy patients had a successful outcome; in those receiving workers' compensation, 69.6% of the chemonucleolysis patients and 60.0% of the laminectomy patients had a successful outcome. No statistically significant differences in improvement rate in neurological symptoms or signs were identified between the two procedures. Overall, 85.1% of the chemonucleolysis patients and 78.5% of the laminectomy patients were employed at follow-up review. To achieve optimum results and eliminate noncandidates for chemonucleolysis, routine use of postmyelography CT is recommended. When properly used, chymopapain chemonucleolysis is an acceptable alternative to surgical discectomy.