Complications of Nucleolysis

Abstract

Few medical therapies have aroused as much controversy and passion as intradiscal chymopapain injection. Following the report by Smith [14], two facts unfavorably influenced some of the medical profession: (a) the absence of incontestable double-blind test studies affirming the efficacy of nucleolysis, and (b) two cases of major neurological complications. Numerous studies have confirmed the definite therapeutic efficacy of nucleolysis in the treatment of discoradicular conflict. However, case numbers 31 and 37 of the Smith report are often quoted despite the fact that it is now known that these two complications cannot be directly imputed to nucleolysis. In case 31 Smith did not respect the axiom that he subsequently proposed: “the success of nucleolysis depends to a great extent on respecting contraindications” The Brown-Sequard syndrome that appeared 6 weeks after the C6-C7 nucleolysis was in fact the evolutive outcome of a cervical hemangioendothelioma. As for case 37, Garvin [6] has shown through an experimental study of epidural and intrathecal injections in animals that the paraplegia due to hemorrhagic arachnoiditis in this patient was the result of Pantopaque myelography [6].