Complications of chemonucleolysis.

Complications in chemonucleolysis are inevitable. However, the incidence of these may be minimized with attention to detail. Proper patient selection, based on a knowledge of the natural history of lumbar disk herniation and elimination of patients with contraindications to diskolysis, will result in a higher success rate with lower incidence of complications in diskolysis. Once the proper patient has been selected, attention must be turned to technique with respect to the use of local anesthesia, appropriate patient positioning, good fluoroscopic control, and two-needle technique for appropriate needle positioning. Immunologic complications can be nearly eliminated with the use of a preoperative enzyme immunoassay test. Carefully considering all of these factors will allow chemonucleolysis to present a safe alternative to disk surgery.