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A prospective randomized trial of chemonucleolysis compared to surgery for soft disc herniation with one year, intermediate and long term outcome: Part II The radiological outcome.

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A prospective randomized trial of chemonucleolysis compared to surgery for soft disc herniation with one year, intermediate and long term outcome: Part II The radiological outcome.

Spine (Phila Pa 1976). 2013 May 3;

Authors: Wardlaw D, Rithchie IK, Sabboubeh AF, Vavdha M, Downing M, Eastmond CJ

Abstract
Study Design: A prospective consecutive series of one hundred patients computer randomised into two groups to have treatment with either chemonucleolysis or surgeryObjective: To compare the radiological findings pre-operatively with the clinical outcome between the groups at one year; 10-13 and 24 – 27 years follow up.Summary of Background Data: Chemonucleolysis was introduced in 1964 and became widely used. Its efficacy was proven by several randomised studies when compared to a placebo and surgery. However, it ceased to be manufactured in 2001Methods: One hundred consecutive patients were entered into the study and randomised according to age, sex and level. Pre-operatively they had antero-posterior and lateral lumbar spine, lateral lumbosacral angle radiographs and a myelogram performed. At 10 – 13 years 32 of the original patients (18 chemonuceolysis and 14 surgery) and at 24 – 27years 45 patients (24 chemonucleolysis and 21 surgery)were assessed by lateral lumbosacral angle radiographs.Results: Using the myelographic findings, small, medium and large herniations were digested by chymopapain with more of the failures being the larger ones. There was an equal degree of degenerative change as measured by disc height loss in the young and older age groups and the degree of degenerative change did not relate to outcome. The size of the defect did not relate to the degree of disc height loss. There was a slight loss of disc height over time in both groups. There was no difference in the loss of disc height between the treatments at any of the follow up time points.Conclusion: Chemonucleolysis is as effective as surgery when assessed according to intention to treat analysis. The loss of disc height over time is the same in both groups. The authors believe that restoration of its availability would be beneficial to patients.

PMID: 23649216 [PubMed – as supplied by publisher]

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