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January 9, 1991


Author Affiliations

Barrington, Ill

Barrington, Ill

JAMA. 1991;265(2):215. doi:10.1001/jama.1991.03460020069030

To the Editor.—  A Diagnostic and Therapeutic Technology Assessment (DATTA) report, published in JAMA, August 18, 1989,1 concluded that chemonucleolysis was neither safe nor effective. This conclusion was based on certain inaccuracies and significant omissions.The DATTA statement notes that, "Chemonucleolysis is not safe if there is nuclear material extruding from the disk." However, animal studies have demonstrated that epidural chymopapain is not harmful at doses of up to 100 times the therapeutic level. Experience in humans verifies this fact.2-5Though the DATTA statement maintains that "current imaging techniques are not infallible and cannot differentiate a protrusion from an extrusion," I believe that the newer magnetic resonance imaging equipment is able to differentiate these diagnoses, as are discograms.The DATTA report states, "Even small intrathecal leaks of chymopapain have a potential for damage to the central nervous system." Chymopapain will cause bleeding from the capillaries of the pia-arachnoid,