Chymopapain chemonucleolysis: CT changes after treatment

The herniated nucleus pulposus (HNP) is a very common disorder. In those patient, who do not respond, more direct therapeutic measures, may be necessary. The chymopapain cheomonuclelysis, after two decades of development, has provided a variable alternative to surgical diskectomy for treatment of HNP. The changes of CT scan follow-up 1 month and 3 month that occur in the disks of those patient who respond to chymopapain chemonucleolysis must be defined and evaluation of temporal radiographic changes may also help clarity mechanism by which chemonucleolysis relieves sciatic pain caused by HNP. The results were as follows: 1. Our data indicates that chymopapain chemonucleolysis was effective in 70% and 90% of patients at both 1 M. and 3 M. follow-up. (average 80%) 2. At 1 M. follow-up, a successful response was noted in 70% of patients, with all significant intervertebral disc space narrowing (average 2.7 mm) and 30% of them showing an observable diminution in the herniated disc fragment (average 0.8 mm). At 3 M. follow-up, a successful response was noted in 90% of patients, with 70% of them showing significant narrowing (average 1.2 mm) and observable diminution in the herniated disc fragment (average 1.5 mm). The refor, with 3 M. follow-up, the CT changes did become more pronounced with greater number of patients exhibiting a diminution of the disk herniation and interspace narrowing, and associated with more progressive improvement of clinical outcome. 3. New vaccum phenomenon and extradiskal effects of chymopapain appear to be absent. 4. At 1 M. follow-up, Housefield Unit (HU) of disk is generally increased (average 8.8 HU) and at 3 M. follow-up, it is decreased (average 6 HU).