The long-term clinical outcome is evaluated for 268 patients after
chymopapain chemonucleolysis for radicular complaints referrable to documented
intervertebral disc disease. The follow-up period for 92% of these patients was 10 years. No complications due to
chymopapain toxicity were observed; 80.1% of patients were relieved of their presenting radicular leg
pain and 75.1% were employed at a capacity equal to or more strenuous than before injection.
Chemonucleolysis was demonstrated to be a safe and effective treatment modality, with long-term results that compare favorably with those of similarly selected patients undergoing open
surgical procedures. In the patients whose
chymopapain therapy failed, the outcome of subsequent open
surgical procedures was not necessarily compromised by prior
chemonucleolysis. A higher rate of failure and subsequent surgical intervention was seen in those patients with
injections performed soon after an unsuccessful open procedure on the same side and at the same interspace, those with workmen's compensation or litigation pending, those with a history of work-related injury, those whose employment involved heavy manual labor or extensive driving, and those whose preinjection spine
x-ray films indicated retrograde
spondylolisthesis.