| Summary: | Chemonucleolysis is an efficient, attractive treatment of herniated lum bar disc. It has several major advantages: it is less invasive than surgery, enables an earlier return to work and is cost-effective. Nevertheless serious complications can occur during or after the procedure. Infections or neurological complications usually follow a technical fault and must be avoided. Anaphylactic reactions are rare but can be fatal: development of simple and reliable skin tests to detect sen sitization against chymopapain is an indispensable way to increase the safety of chemonucleolysis. Failure occurs in about one patient of every five; rigorous patient selection should produce a decreased failure rate. Chemonucleolysis is not a miraculous nor a "magic" treatment. As with all efficient therapeutic methods, it presents advantages, draw backs, and failures. Chemonucleolysis still has passionate partisans and ferocious enemies. The goal of this book will be achieved if chemonu cleolysis becomes a standard, well-accepted, and uncontroversial treat ment modality for herniated lumbar disc. October 1986 J.-F. BONNEVILLE Table of Contents Anatomical Aspects of the Intervertebral Disc . . . . . . . . . 1 J.ROLAND, S.BRACARD, D.FoRLODOU, C.MORET and L.PICARD 9 Principles of Chemonucleolysis Using Chymopapain . M.BENOIST Morphological Study of the Action of Chymopapain on the Intervertebral Disc . . . . . . . . . . . . . . . . . . 17 A. TOURNADE and J. P. BRAUN 23 Indications and Contraindications of Nucleolysis . C.J.MENKES Computed Tomography and Chemonucleolysis 29 M. RUNGE, P. CLERE and J. F. BONNEVILLE Extradural Approach to Needle Placement in Lumbar Intervertebral Disc . . . . . . . . 37 O.TROISIER Practical Problems of Discography . . . . . . . . . . . . .. . . . 45
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