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A Deburge

Publications and source records attributed to A Deburge.

At least 19 recordsLinked to original sources
PubMed1999

Radiologic and computed tomography image evaluation of bone regrowth after wide surgical decompression for lumbar stenosis.

STUDY DESIGN: Retrospective study of bone regrowth after decompressive surgery for lumbar spinal stenosis. OBJECTIVES: To assess bone regrowth at the operation site, to compare the bone regrowth rate calculated from plain radiographs with computed tomographic image examinations, to determine the effects of bone regrowth on clinical outcome, and to investigate the factors promoting bone regrowth. SUMMARY OF THE BACKGROUND DATA: Moderate or marked bone regrowth in a surgical defect has been reported in most patients after decompression for lumbar spinal stenosis. Postoperative bone regrowth is related to recurrence of neurologic symptoms in the middle of and later on in follow-up periods. METHODS: Twenty-three patients who underwent decompressive surgery for lumbar spinal stenosis, with an average follow-up of 8 years, were evaluated retrospectively regarding the degree of bone regrowth at the posterior arch. Early postoperative radiographs and computed tomographic images were compared with those obtained at final follow-up. Bone regrowth at the operation sites was evaluated as a regrowth percentage of the original laminectomy site. RESULTS: Decompressive surgery caused bone regrowth to occur at the operation site in most of the patients. However, this regrowth was mild because the mean bone regrowth rate evaluated from plain radiographs averaged 11% and from computed tomographic images 7.7%. In only 20% of the patients was the bone regrowth rate more than 20%. Changes were found to be more elevated at the facet joint level than at the pedicle level. Evaluations of regrowth obtained from plain films and computed tomographic image examinations were compared. Radiographs seemed to overestimate the bone regrowth. The association of postoperative spinal instability with the development of new bone was statistically significant. No relation between bone regrowth and clinical outcome was found. CONCLUSIONS: Bone regrowth in a surgical defect occurs in most patients after posterior decompression. In this study the bone regrowth rate was mild and did not affect the clinical outcome.

Adult↗
PubMed1998

Spinal deformity and instability after multilevel cervical laminectomy for spondylotic myelopathy.

STUDY DESIGN: A retrospective radiographic and medical record analysis of 58 patients. OBJECTIVES: To describe the incidence and consequences of cervical spinal deformity and instability after multilevel laminectomy in adult patients with myelopathy caused by cervical spondylosis and to determine the usefulness of preoperative dynamic roentgenographic films in the prevention of postoperative destabilization. SUMMARY OF BACKGROUND DATA: Extensive cervical laminectomy has been widely used in the treatment of progressive myelopathy secondary to stenotic conditions. Complications of this procedure, including spinal instability, accelerated spondylotic changes, postoperative spinal deformity, and constriction of the dura mater by formation of extradural scar tissue formation have been recognized. However, the frequency of these complications is probably overestimated, and their effect on clinical outcome remains unknown. METHODS: Fifty-eight patients older than 30 years who underwent a laminectomy at more than three levels without fusion for myelopathy secondary to cervical spondylosis were reviewed retrospectively with an average follow-up of 3.6 years. Functional results were evaluated according to the Japanese Orthopaedic Association's scoring system. Lateral views in neutral position, in flexion, and in extension of the preoperative cervical roentgenograms were analyzed in comparison with the last follow-up films to identify the changes in the curvature of the cervical column, in the range of motion of the neck, and in the intervertebral angular mobility and anteroposterior displacement of the vertebral bodies and finally to quantify the incidence of spinal instability. RESULTS: In 18 patients (31%), postoperative changes in the type of cervical spine curvature developed. Fifteen patients (25%) had destabilization at one or more levels. Deformities of the cervical spine occurring after surgery do not appear to cause symptoms or neurologic abnormalities. Destabilization required repeat surgery in 3 patients. All the levels appearing to be destabilized on the postoperative films were hypermobile on the preoperative dynamic radiographs. Preoperative olisthesis Without hypermobility is not a factor of risk in postoperative destabilization. CONCLUSIONS: The use of preoperative dynamic radiographs should improve the selection of patients undergoing laminectomy for the treatment of multilevel cervical cord compression. Dynamic radiographs may also reinforce the need for such adjunctive procedures as fusion and instrumentation, to prevent postoperative destabilization. Preoperative olisthesis with hypermobility in sagittal or horizontal planes must be fused and instrumented.

Adult↗
PubMed1998

Motor deficit in lumbar spinal stenosis: a retrospective study of a series of 50 patients.

Severe motor weakness is an infrequent symptom in the course of lumbar stenosis. The objectives of this study are threefold: to describe the motor deficit, evaluate the prognosis factors, and determine the type of stenosis most likely to be complicated by motor loss. Fifty consecutive patients with a mean age of 65 years, operated on for a lumbar stenosis and with a severe motor deficit, have been retrospectively studied with a mean follow-up of 38 months. The overall functional result was evaluated according to the Beaujon scoring system. The motor capacity was rated from 0 (complete paralysis) to 5 (normal strength). Prognosis factors were investigated with a multivariate analysis model. Motor weakness was rated as zero 11 times, as one 8 times, as two 8 times, and as three 23 times. According to our rating scale, the overall results were considered excellent in 25 cases, good in 17 cases, and fair in the 8 remaining cases. Regression of motor weakness was complete 15 times, partial 25 times, and null 10 times. In this study, favorable prognosis parameters of motor weakness recovery were as follows: association with a discal herniation, stenosis at one level, preoperative duration of motor weakness <6 weeks, age <65, and monoradicular deficit. In contrast, severity of the initial motor weakness, association with sphincter abnormalities, presence or not of degenerative spondylolisthesis, or of a complete block on the myelogram were not influential variables.

Adult↗
PubMed1998

[Static and dynamic changes of the cervical spine after laminectomy for cervical spondylotic myelopathy].

PURPOSE OF THE STUDY: Extensive cervical laminectomy has been widely used in the treatment of progressive myelopathies secondary to stenotic conditions. Complications of this procedure such as spinal instability, accelerated spondylotic changes, postoperative spinal deformity and constriction of the dura mater by extradural scar tissue formation have been recognized. However, the frequency of these complications is probably overestimated and their consequences on the clinical outcome remain unknown. The purpose of this report was to describe the incidence and consequences of cervical spinal deformity and instability after multilevel laminectomy in adult patients with myelopathy caused by cervical spondylosis and to determine the usefulness of preoperative dynamic films in the prevention of postoperative destabilization. MATERIALS AND METHODS: 30 patients older than 30 years who underwent a laminectomy of more than 3 levels without fusion for myelopathy secondary to cervical spondylosis were reviewed retrospectively with an average follow-up of 5 years. Functional results were evaluated according to the Japanese Orthopaedic Association scoring system. Lateral views in neutral position, in flexion and in extension of the preoperative cervical roentgenograms were analyzed in comparison with the last follow-up one in order to identify the changes in the curvature of the cervical column, in the range of motion of the neck, in the intervertebral angular mobility and antero-posterior displacement of the vertebral bodies, and finally to identify the incidence of spinal instability. RESULTS: 18 patients (31 per cent) developed postoperative changes in cervical spine curvature. 15 patients (25 per cent) had one or more destabilized levels. Deformities of the cervical spine occurring after surgery do not appear to cause any symptom or neurologic abnormalities. Destabilization required repeat surgery in 3 patients. All the levels found destabilized on the postoperative films were hypermobile on the preoperative dynamic radiographs. A preoperative olisthesis without hypermobility was not a risk factor for postoperative destabilization. CONCLUSION: The use of preoperative dynamic radiographs should improve the selection of patients undergoing laminectomy for the treatment of multilevel cervical cord compression. Dynamic X-rays may also reinforce the need for possible adjunctive procedures such as fusion and instrumentation, in order to prevent a postoperative destabilization. A preoperative olisthesis with a hypermobility in sagittal or horizontal planes must be fused and instrumented.

Aged↗
PubMed1998

[Fractures of the ischium after laminoarthrectomy. Retrospective study of a series of 31 patients].

PURPOSE OF THE STUDY: Pars interarticularis fracture is one possible source of pain after laminoarthrectomy. The purposes of this study were: to describe the pars defect, to determine its causes and to analyse its consequences on the functional final result. MATERIAL AND METHOD: 31 patients operated for disc herniation or degenerative lumbar stenosis were retrospectively studied. Clinical symptoms were evaluated before and 3 months after initial surgery, at the time of postlaminectomy radiological examination and at last follow-up according to Beaujon rating scale. Radiological evaluation included: description of the pars defect on plain radiographs and CT imaging, calculation of the amount of bone just above the inferior articular process that was resected, analysis of the postoperative stability of the spine both on static and dynamic radiographs. Any remaining disc herniation or stenosis were also noted. RESULTS: 39 pars interarticularis fractures were disclosed. These fractures were identified as a linear luency on plain radiographs or on reformed CT imaging view. Asymmetric widening of the facet joint space just below the pars defect was easier to observe and was present in 66 per cent of the cases on plain radiographs and in 79 per cent on CT imaging. After initial surgery 12 slipping appeared. In all of these cases pars fracture was bilateral at the same level or associated to a complete unilateral facetectomy at the same level. The amount of bone resected just above the inferior facet process was 66 per cent in average, range from 45 to 84 per cent. All the patients complained for low back pain and/or leg pain. In 62 per cent of cases symptoms occurred within one year after surgery, at an average onset of 7.6 months postlaminectomy. 27 patients were reported Revision surgery was in all cases a posterolateral fusion with or without instrumentation; new decompression was performed in 15 cases. At last follow-up, according to our classification, results were very good in 9 cases, good in 15 cases and fair in the remaining 3 cases. Improvement rate obtained after the initial surgery was 75 per cent in average, it was 59 per cent after revision surgery, difference was statistically significant. CONCLUSION: Pars interarticularis fractures may be a source of postlaminectomy pain. They appear to be caused primarily by an excessive resection (more than one half) of the bone immediately superior to the inferior articular process at the level of the laminectomy. These results suggest that caution in resection of this bone or additional posterolateral fusion in case of large resection of pars interarticularis, can avoid the problem. Asymmetric widening of the joint space just below the defect seems to be the key to this diagnosis in the postoperative lumbar laminectomy patient with persistent or recurrent pain.

Adult↗
PubMed1997

[Severe motor weakness associated with lumbar spinal stenosis. A retrospective study of a series of 61 patients].

PURPOSE OF THE STUDY: Severe motor weakness is a rather infrequent symptom in the course of lumbar stenosis. The objectives of this study are three fold: describe the motor deficit, evaluate the prognosis factors and determine the type of stenosis the most likely to be complicated by motor loss. MATERIAL AND METHODS: 61 consecutive patients with a mean age of 63 years, operated on for a lumbar stenosis and with a severe motor deficit have been retrospectively studied. The mean follow-up was 38 months. The overall functional result was evaluated according to a rating scale, specially developed in our unit for the follow-up of lumbar stenosis. The motor capacity was rated from 0 (complete paralysis) to 5 (normal strength). According to that scale the motor weakness was rated as 0, 11 times as 1, 11 times, as 2, 11 times and as 3, 28 times. The deficit was unilateral in 79 per cent of cases and multiradicular in 58 per cent of patients. Sphincter abnormalities were also present in 9 cases. In 9 out of 10 patients the motor deficit was in the L5 territory. Stenosis was extended to 3 levels in 30 cases and was focal in the remaining cases. Degenerative spondylolishthesis was disclosed in 20 patients. In 3 out of 4 cases decompression was performed after 3 weeks of motor weakness and within 3 weeks in the remaining cases. RESULTS: According to our rating scale the overall results were considered excellent in 29 cases, good in 21 cases and fair in the 11 remaining cases. There was no complication, and no postoperative worsening of the deficit was observed. Regression of motor weakness was complete 22 times, partial 29 times and null 10 times. In the eleven complete deficits with a 0 cotation one receded completely, 7 receded partially and no improvement was noted in the 3 remaining cases. 6 out of the 9 patients with sphincter abnormalities recovered completely. In this study favourable prognosis parameters were as follows: age under 62 years, monoradicular deficit, stenosis at one level and association with a discal herniation. In contrast, severity of the initial motor weakness, association with sphincter abnormalities, presence or not of degenerative spondylolisthesis, or of a complete block on the myelogram were not influential variables. Chances of recovery were statistically diminished when decompression was performed after 6 weeks. DISCUSSION AND CONCLUSION: No study dealing specifically with the postoperative outcome of motor deficit caused by lumbar stenosis has been published. However the rate of motor recovery (complete or partial) disclosed in our series is comparable with that found in other series dealing more generally with the overall post-surgery outcome. At our last follow-up, 82 per cent of our patients were considered as having an excellent or good result. It can be concluded that the existence of a motor deficit is not a major pejorative factor of the overall final functional result. Motor weakness is more frequently observed in elderly patients, in cases with degenerative spondylolisthesis, or when a discal herniation is associated with a bony compression. Chances of recovery are better, when the deficit is monoradicular, when the stenosis is focal, or associated with a discal herniation and when the patient is relatively young.

Adult↗
PubMed1997

[Long-term outcome at adjacent levels of lumbar arthrodesis].

Posterolateral lumbar fusion is commonly recognized to have a significant effect upon the more proximal unfused segments. Wether these effects are clinically significant remains unclear. Long term studies with standardized follow-up are scarce. The purpose of this study was to examine the long term roentgenographic and clinical effects of posterolateral fusion upon the 3 cephalad unfused segments. The levels below a floating fusion were also examined. The factors promoting the occurrence of degenerative changes on standard or dynamic x rays were also investigated with a multivariate analysis model. 102 patients who underwent a posterolateral fusion were retrospectively reviewed with an average follow-up of 8.9 years. 39 patients (group I) were fused for low back pain caused by isthmic lysis spondylolisthesis, 15 (group II) for degenerative disc disease and 48 (group III) in addition to a posterior decompression for a lumbar spinal stenosis. Pre and postoperative standard and dynamic roentgenograms were compared in order to study: evolution of the disc space height, modifications in the angular and antero-posterior mobility, modifications in the antero-posterior displacement of the vertebral bodies. Degenerative changes were frequent. 49 per cent of the patients demonstrated a severe disc space narrowing, 30 per cent developed a degenerative spondylolisthesis, 32 per cent an angular hypermobility and 35 per cent an antero-posterior hypermobility. Only one factor was found to increase significantly the occurrence of degenerative changes: the indication of lumbar fusion. Degenerative changes were significantly more frequent in group III's patients. However, no significant correlation was found between the roentgenographic findings and the final functional results and only 8 patients required a new surgery. These results may suggest that posterolateral fusion accelerates the development of degenerative changes in adjacent discs if the fusion is performed on a degenerative spine.

Adolescent↗
PubMed1997

[Long-term osseous changes in the posterior arch after laminectomy for lumbar stenosis].

PURPOSE OF THE STUDY: Many studies have indicated favorable results of decompressive surgery for symptomatic lumbar spinal stenosis. However, little is known about the osseous changes that occur at the operative sites. Postacchini in 1992 and Chen in 1994 have studied, only from plain radiographs, osseous changes at the operative sites, and have suggested that bone regrowth possibly affects the neurologic result. The aims of this study were: to assess bone regrowth at the operative site, to compare the bone regrowth rate calculated from plain radiographs and CT-Scan examinations, to determine the effects of bone regrowth on clinical outcome, to investigate the factors promoting the bone regrowth. MATERIAL AND METHOD: 28 patients who underwent decompressive surgery for lumbar spinal stenosis were retrospectively studied with an average follow-up of 8.4 years. In order to evaluate the degree of bone regrowth at the posterior arch, early postoperative radiographs and CT images of the operative sites were compared with those obtained at final follow-up. Bone regrowth at the sites operated upon was evaluated as a percentage of regrowth of the original laminectomy site based upon plain radiographs and CT images. RESULTS: Decompressive lumbar spinal stenosis is responsible for bone regrowth at the operative site in most patients. However, this regrowth was mild, the mean bone regrowth rate evaluated from plain radiographs was 12 per cent in average and the obtained from CT images was 8.2 per cent in average. Changes were found to be predominant at the facet joint level compared to the pedicle level. The evaluation of regrowth obtained from plain films and CT image examinations were compared. Radiographs seem to overestimate bone regrowth. Postoperative spinal instability was statistically significantly associated with new bone development. This variable was the only factor that affected the degree of bone regrowth. No relationship between bone regrowth and clinical outcome was found. DISCUSSION AND CONCLUSION: Natural course of laminectomy defect includes probably new bone formation in most patients. New bone results from gradual regrowth of the laminae and articular processes partially resected at surgery and from coalescence of islets of bone tissue within the tissue filling the laminectomy defect. In the present study bone regrowth rate was moderate but in other ones it was marked. If some factors (like postoperative destabilization) promoting bone regrowth were identified many remain unknown. Factors influencing rapidity of regrowth progression remain also unknown. Patient's intrinsic features such as spinal stenosis characteristics are probably closely related to quantitative and kinetic characteristics of regrowth. Consequences of bone regrowth are also variable: in some cases regrowth may reproduce pathological conditions identical previous ones, in other ones new bone spreads around the dura a mater without any nerves roots compression. Study of bone regrowth requires further research including prospective studies and using a more precise method for the regrowth evaluation.

Adult↗
PubMed1996

Cervical pseudarthrosis in ankylosing spondylitis. A case report.

STUDY DESIGN: This report illustrates two different cases of cervical pseudarthrosis in ankylosing spondylitis. OBJECTIVES: To point out the extreme rarity of this condition at cervical level, to discuss the pathogenesis, and to stress the necessity of surgical management. SUMMARY AND BACKGROUND DATA: Pathogenesis of pseudarthrosis in ankylosing spondylitis is discussed. Several factors are involved: trauma, which may be major or minor and undetected; stress fracture; and inflammatory changes. Major trauma was the cause of pseudarthrosis in the first patient, whereas stress fracture and inflammatory changes were the probable causes in patient 2. In patient 1 there were signs and symptoms of cord compression. Patient 2 was referred because of functional disability resulting from kyphosis and because of potential neurologic risk. METHODS: Cervical fusion was performed in both patients. Patient 1 underwent posterior fusion; patient 2 had combined fusion. Patient 1 also underwent a lamineotomy. RESULTS: The course of the disorder after surgery was uneventful in both patients. Neurologic symptoms subsided in patient 1; kyphosis was corrected in patient 2. Both patients resumed their preoperative activities. Follow-up evaluation was done 6 years after surgery in patient 1 and 2 years after surgery in patient 2. CONCLUSIONS: Pseudarthrosis of the cervical spine in ankylosing spondylitis is extremely rare. Presentation of the two patients was different in terms of pathogenesis and signs and symptoms. Surgical treatment is advocated for this disorder.

Cervical Vertebrae↗
PubMed1996

Posterolateral fusion for radicular pain in isthmic spondylolisthesis.

Reported is the outcome for 25 patients in whom spondylolisthesis with radicular pain was treated by posterolateral fusion alone (Group A). These outcomes are compared with those obtained in 23 other patients with the same symptomatology and spondylolisthesis treated by root release and posterolateral fusion (Group B). Most patients had Grade I or II isthmic spondylolisthesis. Results were assessed functionally and radiographically with an average followup of 32 months. Posterolateral fusion in situ provided excellent or good results in 88% of patients according to the modified classification of Stauffer and Coventry. In Group A, radicular pain at exertion disappeared in 92% of patients, and radicular pain at rest disappeared in 88%. In Group B, radicular pain at exertion disappeared in 65% of patients, and radicular pain at rest disappeared in 70%. There was no significant statistical difference between the 2 groups. Resection of the loose lamina and root decompression do not seem to be mandatory. The overall fusion rate was 81%. Instrumentation in case of instability and the use of allografts are advised.

Adolescent↗
PubMed1995

Chemonucleolysis: correlation of results with the size of the herniation and the dimensions of the spinal canal.

The aim of this study was to determine whether the results of chemonucleolysis are related to the size of the disc herniation and to the dimensions of the spinal canal. Short and long-term results (average follow-up 4 and a half years) of 148 patients were evaluated. Measurements made with a divider included the size of the disc herniation related to the sagittal diameter of the spinal canal at the discal level and the transverse interligamentous diameter at the level of the facet joints. The morphology of the lateral recess was also assessed. Measurements were initially made by five observers and were repeated eight times and on eight computed tomography (CT) scans in order to assess intra- and interobserver variability. Measurements of the entire series were then made by the two observers demonstrating a good intra- and interobserver reproducibility. Of the 148 patients 74% had an overall successful result. No significant difference was disclosed when comparing the various parameters of the clinical results with the size of the herniation. Similarly, a lack of correlation was also found between the clinical results and the dimensions of the spinal canal and of the lateral recess. In this series, the results were not significantly influenced by the size of the herniation or the morphology of the spinal canal.

Humans↗
PubMed1995

Traumatic atlantooccipital dislocation with survival: case report and review of the literature.

We present the case of a patient with traumatic atlantooccipital dislocation. The initial neurological examination showed no abnormalities. Dislocation was the result of rapid deceleration in a motor vehicle accident. The mechanism of injury was hyperextension/rotation, probably combined with a distraction force. Only a few cases of atlantooccipital dislocation without neurological involvement have been reported. Every report pointed out difficulties of initial diagnosis. Special attention should be directed toward the atlanto-odontoid-basion relationships as seen on lateral radiographs. Prompt recognition and surgical stabilization are essential to avoid further neurological injury.

Adult↗
PubMed1995

Unstable degenerative spondylolisthesis of the cervical spine.

Unstable degenerative spondylolisthesis of the cervical spine is very rare. Slip usually occurs at the C3 on C4 or C4 on C5 levels, immediately above a stiff lower cervical spine. There are two clinical patterns: that with neurological involvement causing cervicobrachial pain or myelopathy and that with neck pain alone. The diagnosis can be made by flexion/extension radiography. All of our eight patients had localised fusion, three anterior and five posterior, and all had satisfactory results one to seven years after operation.

Aged↗
PubMed1995

[Reoperations after surgical treatment of lumbar stenosis].

UNLABELLED: PURPOSE THE STUDY: The aim of this study was to determine the causes of failure following surgical treatment of lumbar spinal stenosis, indications for redo surgery and factors influencing the final result. MATERIAL AND METHODS: Between 1975 and 1992, 38 patients were reoperated after a surgical treatment of lumbar spinal stenosis. The mean follow-up was 34 months. All of these patients had had at least one previous lumbar spinal operation. Second operation was performed 35 months on average following the previous surgery. CLINICAL EVALUATION: The grading scale used in this review assessed walking ability, radicular pain at rest and at exersion, back pain, motor deficit and sphincter dysfunction. Patients were evaluated before and after the 2 surgeries and at last follow-up. Radiological study was done from CT-scan, MRI, myelograms, static and dynamic standard X-rays before the first surgery and following the revision surgery. RESULTS AND DISCUSSION: According to our grading scale the final result was very good for 36 per cent of the patients, good for 24 per cent, fair for 24 per cent and poor for 16 per cent. The main causes of failure were post-operative destabilization and incomplete neurological decompression. In 56 per cent of our cases initial nerve roots decompression was incomplete: disc excision without bone resection in case of lumbar stenosis associated with disc herniation, incomplete lateral release, decompression of the symptomatic nerve roots only and not of all of them that were compressed. In these cases revision surgery was comprised by a new decompression. In 25 per cent of our cases post-operative destabilization was the cause of failure. During the previous surgery bone resection had been extensive: total bilateral facetectomy without fusion, wide laminectomy extended into the pars inter-articularis, resulting in isthmic fracture. Revision surgery was a posterolateral fusion with or without instrumentation generally associated with a new decompression. Two patients were reoperated on without evidence of inadequate decompression or destabilization. Result was poor in both. Final results were statistically better when the cause of revision surgery was a post-operative destabilization and when redo surgery was performed on surgically untouched levels. CONCLUSION: Final results were disappointed since only 60 per cent were good or very good results. Revision surgery should be avoided, by using pre-operative planning of the neural decompression, and by adding a fusion if a wide bone resection is necessary.

Adult↗
PubMed1994

The iatrogenic spine.

Explore the source record for details and available documents.

Fracture Fixation, Internal↗
PubMed1993

A randomized, double-blind study to compare low-dose with standard-dose chymopapain in the treatment of herniated lumbar intervertebral discs.

Postoperative low-back pain and spasm are the main drawbacks of chymopapain chemonucleolysis. To investigate if low-dose chymopapain could reduce this adverse reaction, without modifying the efficacy, 118 patients with persistent low-back and radicular pain due to a lumbar disc herniation underwent chemonucleolysis. 60 patients were randomly selected to receive 2 mL of standard-dose chymopapain (4,000 units) and 58 to receive 2 mL of low dose (2,000 units). The clinical outcome was assessed on study days 1, 30, and 60, and after 1 year by physicians who were unaware of the treatment, and on the basis of the patients' self evaluation. At day 60, Chemonucleolysis was rated as successful in 81% of the cases by the investigator and in 80% by the patient's self assessment. The percentage of good results was remarkably similar in the two treatment groups and this finding was confirmed after 1 year. There was some evidence that the low-dose treatment resulted in less frequent postoperative back pain but the difference was not statistically significant. Moreover, a comparable incidence of acute low-back pain and spasm was observed in the two treatment groups. Low-dose chemonucleolysis appears to be as effective as the standard dose, but the use of 2,000 units does not significantly lower the postoperative back pain.

Adult↗
PubMed1993

[Herniation of a lumbar disk in the elderly. Results of chemonucleolysis].

The purpose of this study was to evaluate the outcome after chymopapain chemonucleolysis in elderly patients with low back pain and sciatica due to lumbar disc herniation without concomitant stenosis, unresponsive to conservative therapy. In the 42 study patients, aged 60 years or older, clinical manifestations were similar to those usually seen in younger patients. Evidence of nerve root tension, including a positive straight-leg raising test seen in 67% of our patients, proved valuable for outruling sciatica due to bony impingement. Outcome was favorable in 78% of cases after a mean follow-up of 2.5 years. This findings is consistent with previous studies performed without age restrictions. Chemonucleolysis had no adverse effects. Despite the biochemical changes which occur in the aging disc, chemonucleolysis is an effective tool for the treatment of sciatica due to disc herniation in elderly patients.

Aged↗