ABSTRACT
Chemical dissolution or chemonucleolysis of a lumbar disc herniation involves the intradiscal injection of an enzyme, such as chymopapain or purified collagenase. The most common form of enzymatic intradiscal therapy is chymopapain, which was isolated from the latex of the Carica papaya fruit. Chymopapain is only indicated in the treatment of clinically significant sciatica as a result of herniated lumbar nucleus pulposus that has not responded to nonoperative measures such as physiotherapy, nonsteroidal anti-inflammatories, and nerve root blocks, for at least six-week period. Chemonucleolysis requires a radiolucent table and C-arm fluoroscope or bi-planar fluoroscopy. Chemonucleolysis is a minimally invasive treatment option for symptomatic lumbar disc herniations. It is an intermediate option between nonoperative measures and surgical microdiscectomy for soft contained lumbar disc herniations. Chymopapain is no longer manufactured or available in most parts of the world including Canada and Europe.
