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Chemonucleolysis

Chemonucleolysis is a minimally-invasive, outpatient procedure that is used as a treatment for bulging discs in the back and neck. This procedure involves a surgeon injecting an enzyme, chymopapain (derived from papaya), into the nucleus pulpous of the symptomatic disc to decrease the swelling and provide pain relief. This procedure, however, is not regularly used in America because of concerns over potential allergic reactions and questions of its relative effectiveness.

To better understand chemonucleolysis requires a closer look at what a bulging disc actually is. Resting between each spinal vertebra is a soft pad of joint cartilage that acts as the spine’s shock absorber. These discs are comprised of a jelly-like center, called the nucleus pulpous, and an outer fibrous ring, called the annulus fibrosus. In the event that the nucleus pulpous expands, the disc may extrude into the spinal canal and compress a nearby nerve, causing pain. The introduction of chymopapain from chemonucleolysis expedites the breakdown of the nucleus, theoretically shrinking the disc, decompressing the nerve, and alleviating the patient’s pain.

While this sounds good on paper, there are a number of concerns with chemonucleolysis, namely:

• Some patients exhibit serious allergic reactions to chymopapain
• The medical community isn’t convinced the procedure is entirely effective and it only treats bulging discs, not the potential underlying issue causing the disc disorder
• The procedure may not sufficiently alleviate back pain or neck pain, meaning later surgery could still be required

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Patients typically elect to try chemonucleolysis because it is a minimally-invasive alternative to open-back surgery. Fortunately, another option for treating bulging discs (and many other disc disorders) exists. A procedure known as a percutaneous endoscopic discectomy at Laser Spine Institute (LSI) is an outpatient, laser-guided procedure where the surgeon is able to surgically remove or shrink the part of the bulging disc that is causing compression without removing the entire disc.

To learn more about bulging disc treatments, both surgical and nonsurgical, contact the award-winning staff at Laser Spine Institute (LSI). The surgeons at LSI are at the forefront of endoscopic laser surgery, which offers a compelling alternative to neck and back pain without the potential risks of open-back surgery or chemonucleolysis.

Please note: Laser Spine Institute currently does not perform endoscopic procedures on the thoracic spine.