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January 2, 1987

Chemonucleolysis and Microsurgery for Lumbar Disk Disease

Author Affiliations

Akron, Ohio

Akron, Ohio

JAMA. 1987;257(1):28. doi:10.1001/jama.1987.03390010032016

To the Editor.—  It is unfortunate that the article by Beverly Merz1 did not include some important points. Given that, I agree that surgeons who do not grasp the indications for and technical factors involved in chemonucleolysis will not get good results, may cause complications, and should give up the procedure.The setback to chemonucleolysis in North America occurred because of poor training of surgeons—the effort to train surgeons was so massive and so sudden that at best their skills were immature. Is it any wonder that a number of technical problems occurred with chymopapain injection?The patient with a soft-disk herniation causing sciatica who will respond to a chymopapain injection has relatively severe pain in the leg (compared with back pain) and has marked reduction of straight-leg raising, as well as neurological symptoms and signs. I am sure that Dr Shields would quickly admit that his series did