Focus on Chemonucleolysis

1. Front Matter

   Pages I-X

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2. Anatomical Aspects of the Intervertebral Disc

   • J. Roland, S. Bracard, D. Forlodou, C. Moret, L. Picard

   Pages 1-7

3. Principles of Chemonucleolysis Using Chymopapain

   • M. Benoist

   Pages 9-16

4. Morphological Study of the Action of Chymopapain on the Intervertebral Disc

   • A. Tournade, J. P. Braun

   Pages 17-22

5. Indications and Contraindications of Nucleolysis

   • C. J. Menkes

   Pages 23-27

6. Computed Tomography and Chemonucleolysis

   • M. Runge, P. Clere, J. F. Bonneville

   Pages 29-35

7. Extradural Approach to Needle Placement in Lumbar Intervertebral Disc

   • O. Troisier

   Pages 37-43

8. Practical Problems of Discography

   • A. Chevrot, F. Girès, C. Vallée, M. Revel, M. A. Mayoux-Benhamou

   Pages 45-52

9. Discography in the Prognosis of Chemonucleolysis

   • O. Troisier

   Pages 53-58

10. Discography and Nucleolysis with Discase

    • A. Chevrot, M. F. Bellin, F. Girès, C. Vallée, D. Cormier, M. Revel et al.

    Pages 59-65

11. Advantages of Disc Compliance Recording VS Discography

    • L. Castagnera, B. Lavignolle, J. P. Claverie, B. Destribats, G. Macouillard, J. Senegas

    Pages 67-77

12. Results after Chemonucleolysis

    • P. Clère, M. Runge, J. F. Bonneville

    Pages 79-85

13. Anaphylactic Accidents Related to Chymopapain: Prevention and Treatment

    • M. C. Laxenaire, D. A. Monneret-Vautrain

    Pages 87-99

14. Complications of Nucleolysis

    • P. Courtheoux, J. Theron

    Pages 101-106

15. Failures of Chemonucleolysis

    • H. Deramond

    Pages 107-113

16. Surgical Findings and Results After Chemonucleolysis Failure in Sciatica

    • J. P. Houtteville, K. Toumi

    Pages 115-121

17. The Cost of Chemonucleolysis — A Preliminary Study

    • M. Bochu, C. Demiaux, E. Vignon

    Pages 123-125

18. Chymopapain Cervical Chemonucleolysis: Preliminary Results in 15 Cases

    • A. Bonafe

    Pages 127-132

19. Chymodiactin

    • F. Caulin

    Pages 133-139

20. Presentation of Discolysis Enzyme: Disease (Chymopapain)

    • T. Samson

    Pages 141-145

Chemonucleolysis is an efficient, attractive treatment of herniated lum­ bar disc. It has several major advantages: it is less invasive than surgery, enables an earlier return to work and is cost-effective. Nevertheless serious complications can occur during or after the procedure. Infections or neurological complications usually follow a technical fault and must be avoided. Anaphylactic reactions are rare but can be fatal: development of simple and reliable skin tests to detect sen­ sitization against chymopapain is an indispensable way to increase the safety of chemonucleolysis. Failure occurs in about one patient of every five; rigorous patient selection should produce a decreased failure rate. Chemonucleolysis is not a miraculous nor a "magic" treatment. As with all efficient therapeutic methods, it presents advantages, draw­ backs, and failures. Chemonucleolysis still has passionate partisans and ferocious enemies. The goal of this book will be achieved if chemonu­ cleolysis becomes a standard, well-accepted, and uncontroversial treat­ ment modality for herniated lumbar disc. October 1986 J.-F. BONNEVILLE Table of Contents Anatomical Aspects of the Intervertebral Disc . . . . . . . . . 1 J.ROLAND, S.BRACARD, D.FoRLODOU, C.MORET and L.PICARD 9 Principles of Chemonucleolysis Using Chymopapain . M.BENOIST Morphological Study of the Action of Chymopapain on the Intervertebral Disc . . . . . . . . . . . . . . . . . . 17 A. TOURNADE and J. P. BRAUN 23 Indications and Contraindications of Nucleolysis . C.J.MENKES Computed Tomography and Chemonucleolysis 29 M. RUNGE, P. CLERE and J. F. BONNEVILLE Extradural Approach to Needle Placement in Lumbar Intervertebral Disc . . . . . . . . 37 O.TROISIER Practical Problems of Discography . . . . . . . . . . . . .. . . . 45 .

• complication
• computed tomography
• computed tomography (CT)
• infection
• surgery
• tomography

• Département de Neuroradiologie Hôpital Jean Minjoz, Centre Hospitalier et Universitaire de Besancon, Besancon, Cedex, France

  Jean-François Bonneville

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