This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
The patient has clear-cut lumbar disk protrusion. His lower back and leg pain is unremitting. He cannot carry out his everyday activities, and four weeks of bed rest, analgesics, and physiotherapy have not helped.
This patient, among the estimated 1% of adult Americans who will have a herniated disk at some time in their lives, could be considered for intradiscal therapy with chymopapain. However, emphasize the American Association of Neurological Surgeons (AANS) and the American Academy of Orthopaedic Surgeons (AAOS), joint sponsors of a number of one-day courses in the procedure: "Ideal candidates for chymopapain injection are also the ideal candidates for surgery."
If chymopapain chemonucleolysis is chosen, it is performed either in the operating room or in a radiology department's special-procedures room equipped for sterile surgical techniques.
The anesthetized patient (either local or general anesthesia is used) usually is taped to the special operating table on the left side,
Gunby P. What is intradiscal therapy, anyway?. JAMA. 1983;249(9):1120-1123. doi:10.1001/jama.1983.03330330008003