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July 18, 1986

The Honeymoon Is Over: Spinal Surgeons Begin To Divorce Themselves from Chemonucleolysis

JAMA. 1986;256(3):317-318. doi:10.1001/jama.1986.03380030019005

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"HOW MANY of you have performed this procedure?" the speaker asked the packed auditorium. Some 300 hands went up.

He pursued the questioning: "How many of you still do it?" Six hands were raised.

The poll was informal, conducted as a coda to a series of presentations on chemonucleolysis therapy for herniated lumbar disks at the recent meeting of the American Association of Neurological Surgeons (AANS) in Denver. But it says a lot about how neurosurgeons' opinions of the technique have changed in the few years since the chymopapain enzyme injection received FDA approval (JAMA [MEDICAL NEWS] 1983;249:1115-1123).

As neurological surgeons' experience with the procedure has grown, so has their discontent. Early rumblings were detected at the annual meeting of the Congress of Neurological Surgeons (CNS) late in 1983. At that meeting, surgeons who were performing the procedure reported failure rates of 5% to 33% (JAMA [MEDICAL NEWS] 1984; 251:13-15,