{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T12:30:15Z","timestamp":1772109015482,"version":"3.50.1"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1992,2]]},"abstract":"<jats:p content-type=\"fine-print\">\u2713 To help clarify the comparative effects of chemonucleolysis and discectomy, the author studied 178 consecutive patients with sciatica who did not respond to conservative treatment. None had previously undergone laminectomy or chemonucleolysis or had spinal stenosis. All received postmyelography computerized tomography (CT) and, if the radiological interpretation was that of an extruded migrated disc, a laminectomy was performed; otherwise, the patient was given a choice of the two procedures. Of the 178 patients, 106 underwent chemonucleolysis and 72 laminectomy. Workers' compensation was being paid to 21.6% of the chemonucleolysis patients and 20.8% of the laminectomy patients.<\/jats:p>\n<jats:p content-type=\"fine-print\">Postoperatively, substantial improvement was noted in 82.7% of the chemonucleolysis patients and 92.5% of the laminectomy patients at 6 weeks and in 92.8% of the chemonucleolysis patients and 89.7% of the laminectomy patients at 6 months. The majority of patients in both groups had improved neurological signs. Follow-up questionnaires at 1 to 4 years postoperatively revealed an overall success rate of 86.5% for chemonucleolysis patients and 83.8% for laminectomy patients. In patients not receiving workers' compensation, 90.1% of the chemonucleolysis patients and 88.6% of the laminectomy patients had a successful outcome; in those receiving workers' compensation, 69.6% of the chemonucleolysis patients and 60.0% of the laminectomy patients had a successful outcome. No statistically significant differences in improvement rate in neurological symptoms or signs were identified between the two procedures. Overall, 85.1 % of the chemonucleolysis patients and 78.5% of the laminectomy patients were employed at follow-up review.<\/jats:p>\n<jats:p content-type=\"fine-print\">To achieve optimum results and eliminate noncandidates for chemonucleolysis, routine use of postmyelography CT is recommended. When properly used, chymopapain chemonucleolysis is an acceptable alternative to surgical discectomy.<\/jats:p>","DOI":"10.3171\/jns.1992.76.2.0184","type":"journal-article","created":{"date-parts":[[2009,5,26]],"date-time":"2009-05-26T20:11:28Z","timestamp":1243368688000},"page":"184-190","source":"Crossref","is-referenced-by-count":26,"title":["A 1- to 4-year follow-up review of treatment of sciatica using chemonucleolysis or laminectomy"],"prefix":"10.3171","volume":"76","author":[{"given":"Manucher J.","family":"Javid","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Clin Orthop","first-page":"158","article-title":"Chymopapain chemonucleolysis versus surgical discectomy in a military population.","volume":"244","author":"Alexander","year":"1989"},{"key":"b2","series-title":"Acta Orthop Belg","first-page":"48","article-title":"Complications of discal hernia therapy. 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A prospective study with random assignment.","volume":"174","author":"Ejesk\u00e4r","year":"1983"},{"key":"b7","series-title":"Clin Orthop","first-page":"68","article-title":"Experimental study of chymopapain in cats.","volume":"67","author":"Ford","year":"1969"},{"key":"b8","series-title":"Clin Orthop","first-page":"47","article-title":"Pharmacologic properties of chymopapain.","volume":"67","author":"Gesler","year":"1969"},{"key":"b9","series-title":"Acta Orthop Belg","first-page":"134","article-title":"Comparative study of the results obtained with discectomy and chemonucleolysis.","volume":"42","author":"Hoogmartens","year":"1976"},{"key":"b10","series-title":"JAMA","doi-asserted-by":"publisher","first-page":"2489","DOI":"10.1001\/jama.1983.03330420035030","article-title":"Safety and efficacy of chymopapain (Chymodiactin) in herniated nucleus pulposus with sciatica. Results of a randomized, double-blind study.","volume":"249","author":"Javid","year":"1983"},{"key":"b11","series-title":"Tijdschr Geneesk","first-page":"1129","article-title":"Chemonucleolyse of herniotomie; resultaten van een vergelijkend onderzoek bij pati\u00ebnten met een hernia nuclei pulposi lumbalis.","volume":"132","author":"Keet","year":"1988"},{"key":"b12","series-title":"Clin Orthop","first-page":"136","article-title":"A comparison of patients treated by chymopapain and laminectomy for low back pain using a multidimensional pain scale.","volume":"146","author":"Leavitt","year":"1980"},{"key":"b13","series-title":"Neurosurg Rev","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1007\/BF01743059","article-title":"Sciatica \u2014 management by chemonucleolysis versus surgical discectomy.","volume":"9","author":"LeBlanc","year":"1986"},{"key":"b14","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1056\/NEJM193408022110506","article-title":"Rupture of the intervertebral disc with involvement of the spinal canal.","volume":"211","author":"Mixter","year":"1934"},{"key":"b15","series-title":"Chemonucleolysis in Frymore. The Adult Spine, Principles and Practice.","first-page":"175","author":"Nordby","year":"1991"},{"key":"b16","series-title":"Clin Orthop","first-page":"279","article-title":"A comparison of discectomy and chemonucleolysis.","volume":"200","author":"Nordby","year":"1985"},{"key":"b17","series-title":"Clin Orthop","first-page":"119","article-title":"A comparative analysis of lumbar disc disease treated by laminectomy or chemonucleolysis.","volume":"90","author":"Nordby","year":"1973"},{"key":"b18","series-title":"Spine","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1097\/00007632-198703000-00003","article-title":"Chemonucleolysis versus surgery in lumbar disc herniations: correlation of the results of preoperative clinical pattern and size of the herniation.","volume":"12","author":"Postacchini","year":"1987"},{"key":"b19","series-title":"Spine","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1097\/00007632-198505000-00013","article-title":"Cost effectiveness of chemonucleolysis versus laminectomy in the treatment of herniated nucleus pulposus.","volume":"10","author":"Ramirez","year":"1985"},{"key":"b20","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1227\/00006123-198908000-00012","article-title":"Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals.","volume":"25","author":"Ramirez","year":"1989"},{"key":"b21","series-title":"Minitab Student Handbook.","author":"Ryan","year":"1976"},{"key":"b22","series-title":"JAMA","first-page":"137","article-title":"Enzyme dissolution of the nucleus pulposus in humans.","volume":"187","author":"Smith","year":"1964"},{"key":"b23","series-title":"Chemonucleolysis.","first-page":"11","article-title":"The biochemistry and toxicology of chymopapain","author":"Stern","year":"1985"},{"key":"b24","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"869","DOI":"10.3171\/jns.1989.70.6.0869","article-title":"Chemonucleolysis versus discectomy: a randomized multicenter trial.","volume":"70","author":"van Alphen","year":"1989"},{"key":"b25","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"397","DOI":"10.3171\/jns.1975.42.4.0397","article-title":"Comparison of intervertebral disc disease treatment by chymopapain injection and open surgery.","volume":"42","author":"Watts","year":"1975"},{"key":"b26","series-title":"Clin Orthop","first-page":"50","article-title":"Chemonucleolysis versus open discectomy. 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