Ruptured L5S1-Chemonucleolysis

[James-R-Owsley]

    
      Re: Ruptured L5S1-Chemonucleolysis
    


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Posted by ccf neuro M.D. on May 05, 1997 at 14:15:15:

In Reply to: Ruptured L5S1-Chemonucleolysis posted by James R. Owsley on April 29, 1997 at 17:08:50:

: I suffered a ruptured disk in 1981. I opted for what was known then as an experimental procedure called Chemonucleolysis. The results were immediate relief to the excrutiating pain in my lower back and legs that I had for nearly 6 years.
  Over the last 10 years I have experienced significant lower back pain, numbness in my right leg, my right foot turning in and sharp "grabs" that make me sick to my stomach.
  What I would like to know is if you are familiar with this procedure and what the long term effects are to the disk and surrounding areas and who would be the best recommendation for treatment. A orthopaedic or a neurologist?
  Do you have any statistics on what my outlook is for a "normal" lifestyle. I am a married man with two young children.
  Thanks.
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Chemonucleosis was and remains an experimental and to date unproven treatment for herniated disks. It is not performed at the Cleveland Clinic or most other academic centers of medicine for this reason. In your case, it sounds as if the procedure did bring you some relief. With the described recuureence of your symptoms, however, the obvious question is why have your symptoms returned. Is it due to scarring and/or nerve damage caused by the injected material, or simply a recurrence of the disk herniation itself? It is important to differentiate between these two possibilities since a recurrent disk herniation is treatable by removal of the disk fragment  and decompression of the nerve it is pressing against, whereas scarring of the nerve, sometimes called arachnoiditis, is virtually impossible to treat. An MRI scan or CT-myelogram scan of the lumbrosacral spine can differentiate bewteen the two. The MRI scan with contrast material (gadolinium) is probably best to detect arachnoiditis/scar tissue. In any event I would recommend an evaluation by a neurologist specifically, who could arrange for such tests, which could also include an EMG test to evaluate how the nerves themselves are functioning, which may be useful additional information. Most importantly, a neurologist, unlike an orthopedist, can perform a very sophisticated clinical neurologic examination to guide the appropriate testing and can refer you on to a neurosurgeon or orthopedic surgeon if surgery is deemed the best or one of the best possible treatment options for your individual case. I would not recommend repeat chemonucleosis as this procedure has generally not panned out and is not in current widespread use for disk disease treatment. I hope this information is helpful.