The Journal of Bone and Joint Surgery, Vol 67, Issue 9 1402-1404, Copyright © 1985 by Journal of Bone and Joint Surgery, Inc
Chemonucleolysis for herniated nucleus pulposus in adolescents
M Lorenz and J McCulloch
Fifty-five adolescents between the ages of thirteen and nineteen years
underwent chemonucleolysis for one or more herniated lumbar discs at St.
Michael's Hospital, Toronto, Ontario. The surgery was done by the senior
one of us (J.M.) between 1972 and 1982. The duration of symptoms ranged
from two months to three years. Pain in the lower limb was the predominant
symptom in forty-eight patients. Reduction of the amount of straight
leg-raising by 50 per cent or more, with or without pain in the ipsilateral
hip when the asymptomatic limb was lifted (cross-over pain) and with or
without pain radiating up or down the lower limb when the tibial nerve was
pressed in the popliteal fossa (bowstring discomfort), was considered
evidence of tension on or irritation of the nerve root and was present in
all patients. Chemonucleolysis was considered as an alternative to
discectomy and was performed only after the patient failed to respond to
conservative management. An anaphylactic reaction occurred in one patient
and was treated successfully. The most common symptom after injection was
increased back pain, and it was controlled with medication. One patient had
transient weakness of the extensor hallucis longus after injection. The
length of follow-up ranged from two to twelve years (average, four years
and six months), excluding one patient who was killed in an accident six
months after injection. Chemonucleolysis did not relieve the symptoms in
eleven of the fifty-five patients. These eleven patients all subsequently
had surgical excision of the disc, and in them the chemonucleolysis was
considered to have failed.(ABSTRACT TRUNCATED AT 250 WORDS)
CiteULike 
Connotea 
Del.icio.us 
Technorati What's this?
