Chemonucleolysis revisited: a prospective outcome study in symptomatic lumbar disc prolapse.

Objective: This prospective study was carried out to assess the functional outcome in patients with symptomatic lumbar disc prolapse treated by chemonucleolysis (CNL).

Methods: The Oswestry Low Back Pain Disability Index (ODI) was used to assess the pre- and postprocedure functional status of 112 patients with magnetic resonance (MR) scan-proven lumbar disc prolapse treated by CNL. Follow-up was for at least 5 years.

Results: Ninety-three of 112 patients (83%) had excellent/good results, whereas 11 of 112 (10%) were unchanged and 8 of 112 (7%) were worse after the CNL. The younger patients with single-level discs at L5-S1 had the most successful outcome. Seventy percent of our patients (25-45 years of age) were gainfully employed with a mean return to work at 12 weeks.

Conclusions: CNL is a good procedure to bridge the gap between conservative treatment and surgery for lumbar disc prolapse. CNL is beneficial in 80% of patients with significant leg symptoms. After careful selection of candidates using MR scans, it is an effective procedure that does not compromise future open surgery, should it be necessary.