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Manucher J Javid - One of the best experts on this subject based on the ideXlab platform.

  • Spine Update Chemonucleolysis
    Spine, 1996
    Co-Authors: Eugene J. Nordby, Robert D. Fraser, Manucher J Javid
    Abstract:

    Even with a history of controversy and troubling complications, chymopapain has endured the test of time to show 30 years of clinical success in the treatment of herniated nucleus pulposus. Strict attention to indications, contraindications, and technique ensures safety and efficacy of treatment. A trend to decreased dosage may result in less postinjection spasm. Between 1982-1991, 121 adverse events in 135,000 patients were reported to the Food and Drug Administration and investigated. Seven cases of fatal anaphylaxis, 24 infections, 32 bleeding problems, 32 neurologic events, and 15 miscellaneous occurrences were found. Overall mortality rate was 0.019%. All categories were of lesser incidence than complications with laminectomy. Long-term results show that improvement after Chemonucleolysis is maintained, whereas the outcome after laminectomy is reported to deteriorate with time. Cost savings with Chemonucleolysis over laminectomy are largely a matter of shorter hospitalization. A protocol for cervical Chemonucleolysis is being developed in the United States after good results have been shown in Spain and France. Other enzymes continue under investigation, but chymopapain remains the standard to which they are compared.

  • Chemonucleolysis versus laminectomy a cohort comparison of effectiveness and charges
    Spine, 1995
    Co-Authors: Manucher J Javid
    Abstract:

    Study Design. A prospective cohort study was done comparing 100 consecutive Chemonucleolysis patients with 100 consecutive laminectomy patients. Objectives. The effectiveness and cost of chymopapain Chemonucleolysis was compared with that of laminectomy to manage herniated lumbar discs. Summary of Background Data. Although the efficacy of Chemonucleolysis has been established, controversly regarding the relative benefits of Chemonucleolysis and laminectomy continues to arise. The relative cost-effectiveness of the two procedures has not been evaluated previously in a cohort study. Methods. Patients in both treatment groups were of comparable age, height and weight, and worker's compensation status. Patients with migrated disc were not considered for Chemonucleolysis. Improvement in pain, paresthesia, straight-leg raising, reflexes, motor loss, and sensory function, self-reported overall improvement, ability to maintain employment, and charge of treatment were used to measure treatment success. Results. Clinical assessment after 6 weeks showed 92% of laminectomy patients compared with 82% of Chemonucleolysis patients has successful results (P=0.058). Chemonucleolysis patients had greater improvement in numbness (P=0.014) and sensory and motor functions (P=0.002). After 6 months, 88% of Chemonucleolysis patients and 85% of laminectomy patients had successful results, with a greater improvement in sensory status or Chemonucleolysis patients (P<0.001). After 1 year, 87% of Chemonucleolysis patients and 82% of laminectomy patients had successful results, and more Chemonucleolysis patients than laminectomy patients were employed. Based on similar therapeutic results, the average charge savings for Chemonucleolysis patients was $5365 when Chemonucleolysis was performed instead of laminectomy. Conclusion. This study shows that Chemonucleolysis is as effective as laminectomy in appropriately selected patients but a lower charge and can contribute substantially to reducing short- and long-term health costs.

  • Chemonucleolysis versus laminectomy. A cohort comparison of effectiveness and charges
    Spine, 1995
    Co-Authors: Manucher J Javid
    Abstract:

    Study Design. A prospective cohort study was done comparing 100 consecutive Chemonucleolysis patients with 100 consecutive laminectomy patients. Objectives. The effectiveness and cost of chymopapain Chemonucleolysis was compared with that of laminectomy to manage herniated lumbar discs. Summary of Background Data. Although the efficacy of Chemonucleolysis has been established, controversly regarding the relative benefits of Chemonucleolysis and laminectomy continues to arise. The relative cost-effectiveness of the two procedures has not been evaluated previously in a cohort study. Methods. Patients in both treatment groups were of comparable age, height and weight, and worker's compensation status. Patients with migrated disc were not considered for Chemonucleolysis. Improvement in pain, paresthesia, straight-leg raising, reflexes, motor loss, and sensory function, self-reported overall improvement, ability to maintain employment, and charge of treatment were used to measure treatment success. Results. Clinical assessment after 6 weeks showed 92% of laminectomy patients compared with 82% of Chemonucleolysis patients has successful results (P=0.058). Chemonucleolysis patients had greater improvement in numbness (P=0.014) and sensory and motor functions (P=0.002). After 6 months, 88% of Chemonucleolysis patients and 85% of laminectomy patients had successful results, with a greater improvement in sensory status or Chemonucleolysis patients (P

I. V. Adair - One of the best experts on this subject based on the ideXlab platform.

  • a prospective randomized trial of Chemonucleolysis and conventional disc surgery in single level lumbar disc herniation
    Spine, 1992
    Co-Authors: K. P. Muralikuttan, W. G. Kernohan, R. A. B. Mollan, A Hamilton, I. V. Adair
    Abstract:

    The role of Chemonucleolysis as an alternative to disc surgery is still disputed. The authors conducted a prospective randomized controlled trial of Chemonucleolysis and conventional disc surgery involving 92 patients with L4-5 or L5-S1 disc herniation who failed to respond to conservative treatment. There were 46 patients in each group, matched for demographic, clinical characteristics, and co-interventions. Independent examiners assessed patients before treatment, at 6 weeks after, 3 months after, and 1 year after treatment. A comprehensive method of outcome assessment involving physiological outcome, functional outcome, cost outcome, and psychological outcome was employed. Nine Chemonucleolysis patients and one disc surgery patient required additional surgery for failure of initial treatment (P < 0.02). The outcomes at 6 weeks and at 3 months were better in the surgical group, but at 1 year the differences were not significant. The authors conclude that Chemonucleolysis as a minimally invasive technique produces inferior short-term results and offers no advantage over conventional discectomy.

  • Serum keratan sulphate level following Chemonucleolysis.
    Spine, 1991
    Co-Authors: K. P. Muralikuttan, I. V. Adair, G. Roberts, W. G. Kernohan, E. R. Trimble, R. A. B. Mollan
    Abstract:

    In Chemonucleolysis, accuracy of injection can be in doubt if the patient fails to respond. Discography preceding Chemonucleolysis is associated with increased neurologic complications. Biplane fluoroscopy may fail to provide a clear picture on many occasions. The serum keratan sulphate levels were estimated in patients undergoing Chemonucleolysis to ascertain if this could be used as a biochemical indicator to confirm accurate needle placement and to predict outcome. Serum keratan sulphate levels rose significantly following Chemonucleolysis during the first 3 days (P < 0.01). The rise was not significantly different, however, in patients who had improvement in their leg pain from those who did not improve (P = 0.35). Serum keratan sulphate level estimation before Chemonucleolysis and at 24 or 48 hours following the procedure can be used to confirm accuracy of needle placement, but the rise in keratan sulphate is not predictive of the clinical outcome of the procedure.

Douglas Wardlaw - One of the best experts on this subject based on the ideXlab platform.

  • sciatica caused by disc herniation why is chymopapain Chemonucleolysis denied to our patients
    The International Journal of Spine Surgery, 2016
    Co-Authors: Douglas Wardlaw
    Abstract:

    Background This study was undertaken to assess the long term outcome on the quality of life of patients with sciatica following treatment with Chemonucleolysis, and to assess the complications. Methods This is a retrospective review carried out in a consecutive group of patients suffering from sciatica treated by Chemonucleolysis. Patients were followed up by questionnaires to obtain Macnab score; satisfaction, SF 36, and case note review for complications and repeat spinal surgery. Results Six hundred and five patients (56% males, 44% females) treated over a ten year period from 1991 to 2000 were followed up. Average age was 47 years (range 17 - 88 years). The duration of symptoms prior to treatment averaged 10 months (range 1 - 20 months) and the herniation was confirmed by Myelogram (7%), CT Scan (34%), or MRI (59%). There were 578 single level and 27 double levels treated. Eighty five percent of herniations were typical single level, and 15% were atypical that is: patients with dominant back pain with sciatica, recurrent herniations following surgery at the same level, recurrent herniations at another level following Chemonucleolysis, double levels treated patients with mainly neurological deficits and one cauda equina syndrome. Average follow up was 62 months (range 12 - 123) with a 78% satisfaction rate, with a 14% surgical intervention rate made up of 9% decompression, 1% repeat Chemonucleolysis at another level and 4% fusion rate. SF-36 scores generally correlated with age and sex on scores for the normal local population. Conclusions This is a retrospective study and showed that Chemonucleolysis was effective with a high satisfaction rate. It restores quality of life close to that expected in the population, and is safe with no complications related to the procedure. It is a cost effective daycase procedure with a lasting result.

  • prospective randomized trial of Chemonucleolysis compared with surgery for soft disc herniation with 1 year intermediate and long term outcome part i
    Spine, 2013
    Co-Authors: Douglas Wardlaw, Ian K Rithchie, Adel F Sabboubeh, Mukta Vavdha, Clifford J Eastmond
    Abstract:

    Study design A prospective consecutive series of 100 patients computer randomized into 2 groups to have treatment by either Chemonucleolysis or surgery. Objective To compare the radiological findings preoperatively with the clinical outcome between the groups at 1 year, 10 to 13, and 24 to 27 years of follow-up. Summary of background data Chemonucleolysis was introduced in 1964 and became widely used. Its efficacy was proven by several randomized studies when compared with a placebo and surgery. However, it ceased to be manufactured in 2001. Methods One hundred consecutive patients were enrolled for the study and randomized according to age, sex, and disc level. Preoperatively, their anteroposterior, lateral lumbar spine, and lateral lumbosacral angle radiographs were obtained, and a myelogram was performed. At 10 to 13 years, 32 of the original patients (18 Chemonucleolysis and 14 surgery) and at 24 to 27 years, 45 patients (24 Chemonucleolysis and 21 surgery) were assessed by lateral lumbosacral angle radiographs. Results Using the myelographical findings, small, medium, and large herniations were digested by chymopapain with more of the failures being the larger ones. There was an equal degree of degenerative change as measured by disc height loss in the young and older age groups and the degree of degenerative change did not relate to outcome. The size of the defect did not relate to the degree of disc height loss. There was a slight loss of disc height over time in both groups. There was no difference in the loss of disc height between the treatments at any of the follow-up time points. Conclusion Chemonucleolysis is as effective as surgery when assessed according to intention-to-treat analysis. The loss of disc height over time is the same in both groups. The authors think that restoration of its availability would be beneficial to patients. Level of evidence 1.

  • long term follow up of a prospective randomised study of Chemonucleolysis compared to surgery
    Journal of Bone and Joint Surgery-british Volume, 2013
    Co-Authors: Douglas Wardlaw, M. Vadhva, A. Sabboubeh
    Abstract:

    Purpose of the Study Assessment of long term results of Chemonucleolysis vs. surgery for soft disc herniation Material and Methods From 1982 to 1985, 100 patients with symptomatic disc herniation were randomly allocated to receive either Chemonucleolysis(48) or surgery(52) after a three months trial of conservative treatment. Ten of the Chemonucleolysis had surgery. At 10–13 year follow up, Sixty one of the original 100 patients responded, (32 Chemonucleolysis; 29 surgery). At 25–27 year Forty four patients responded (24 Chemonucleolysis; 20 surgery). Clinical outcome at one year was according to a self-assessment questionnaire: Completely, better improved, the same, or worse, and at the later follow up periods, according to the Macnab criteria. The results of two groups of patients were compared using Chi square and T test for independent samples. The disc height of the affected disc was measured from the lateral lumbar spine radiograph taken pre-operatively, and at the later two time points, and compared to a normal adjacent disc expressed as a percentage. Results The intent to treat clinical outcome results showed a high success rate at one year (93% Chemonucleolysis; 96% surgery completely better or improved); and also at the later two time points with no significant difference between the groups. The radiological data showed no difference in disc height between the groups at any of the time points with some reduction over time with aging. Conclusion There is no difference between the groups in either clinical or radiological outcome over time. Chymopapain, presently not widely available, should be made available again. No conflict of interest No funding obtained This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting.

  • 25 YEAR LONG TERM FOLLOW UP OF Chemonucleolysis
    2012
    Co-Authors: M. Vadhva, Douglas Wardlaw, A. Sabboubeh
    Abstract:

    Assessment of long term results of Chemonucleolysis vs. surgical enucleation in soft disc herniation From 1982 to 1985, 100 patients with symptomatic disc herniation were randomly allocated to receive either Chemonucleolysis or disc enucleation after all these patients had a trial of conservative treatment for three months. The outcome of result was measured using MacNab Criteria with the help of Questionnaire Assessing the patients in clinic 44 patients out of original 100 patients were followed up in the clinic 25 years later. 24 were from Chemonucleolysis group and 20 from the surgical group. According to MacNab criteria 62.5% had excellent or good results and 25% poor results in Chemonucleolysis group and in surgery group 70% had excellent or good results and 10% poor results. Patients with poor result in Chemonucleolysis group consisted of: a) 1 had poor result post TKR, b) 4 were offered surgical enucleation subsequent to failed Chemonucleolysis though they did not seem to benefit from surgery and 1 out of these 4 also had fibromyalgia. c) 1 had poor result after sustaining fracture neck of femur. Poor results in surgical group were due to persistent back pain. The results at 25 year follow-up have shown no statistically significant difference between the patients treated by either Chemonucleolysis or surgery. The added benefit of using the chymopapain injection is that it is of lower cost. Chemonucleolysis should have a wider role in treatment of intervertebral disc herniation.

J Roucoules - One of the best experts on this subject based on the ideXlab platform.

  • automated percutaneous lumbar discectomy versus Chemonucleolysis in the treatment of sciatica a randomized multicenter trial
    Spine, 1993
    Co-Authors: Michel Revel, Jean-denis Laredo, B Lassale, H Carter, E Delmas, Christine Payan, C Salomon, C. Vallee, C Roux, J Roucoules
    Abstract:

    : A randomized clinical trial was conducted to compare the results of automated percutaneous discectomy with those of Chemonucleolysis in 141 patients with sciatica caused by a disk herniation; 69 underwent automated percutaneous discectomy and 72 were subjected to Chemonucleolysis. The principle outcome was the overall assessment of the patient 6 months after treatment. Treatment was considered to be successful by 61% of the patients in the Chemonucleolysis group compared with 44% in the automated percutaneous discectomy group. At 1-year follow-up, overall success rates were 66% in the Chemonucleolysis group and 37% in the automated percutaneous group. Within 6 months of treatment, 7% of the patients in the Chemonucleolysis group and 33% in the discectomy group underwent subsequent open surgery. The complication rates of both treatment groups were low, with the exception of a high rate of low-back pain in the Chemonucleolysis group (42%). The results of this trial confirm previous controlled studies on Chemonucleolysis and suggest that controlled studies should be carried out before automated percutaneous discectomy can be considered a useful intervention.

Clifford J Eastmond - One of the best experts on this subject based on the ideXlab platform.

  • prospective randomized trial of Chemonucleolysis compared with surgery for soft disc herniation with 1 year intermediate and long term outcome part i
    Spine, 2013
    Co-Authors: Douglas Wardlaw, Ian K Rithchie, Adel F Sabboubeh, Mukta Vavdha, Clifford J Eastmond
    Abstract:

    Study design A prospective consecutive series of 100 patients computer randomized into 2 groups to have treatment by either Chemonucleolysis or surgery. Objective To compare the radiological findings preoperatively with the clinical outcome between the groups at 1 year, 10 to 13, and 24 to 27 years of follow-up. Summary of background data Chemonucleolysis was introduced in 1964 and became widely used. Its efficacy was proven by several randomized studies when compared with a placebo and surgery. However, it ceased to be manufactured in 2001. Methods One hundred consecutive patients were enrolled for the study and randomized according to age, sex, and disc level. Preoperatively, their anteroposterior, lateral lumbar spine, and lateral lumbosacral angle radiographs were obtained, and a myelogram was performed. At 10 to 13 years, 32 of the original patients (18 Chemonucleolysis and 14 surgery) and at 24 to 27 years, 45 patients (24 Chemonucleolysis and 21 surgery) were assessed by lateral lumbosacral angle radiographs. Results Using the myelographical findings, small, medium, and large herniations were digested by chymopapain with more of the failures being the larger ones. There was an equal degree of degenerative change as measured by disc height loss in the young and older age groups and the degree of degenerative change did not relate to outcome. The size of the defect did not relate to the degree of disc height loss. There was a slight loss of disc height over time in both groups. There was no difference in the loss of disc height between the treatments at any of the follow-up time points. Conclusion Chemonucleolysis is as effective as surgery when assessed according to intention-to-treat analysis. The loss of disc height over time is the same in both groups. The authors think that restoration of its availability would be beneficial to patients. Level of evidence 1.