Adolescent disc protrusions. A long term follow-up of chymopapain therapy.

The management of adolescent disc protrusions by chemonucleolysis has received little attention in the literature, and reports of the long-term outcome are lacking. Between May 1978 and July 1986 42 patients between the ages of 13 and 19 years with radiologically proven lumbar disc protrusions were treated at this institution with chymopapain. They were followed prospectively for 1 year, and the procedure was successful in 27 patients (64%). Of the 15 patients in whom the treatment failed, 11 underwent subsequent surgical discectomy, successful in 10, giving an overall treatment success rate of 37/42 (88%) at 1 year. The patients were contacted by telephone and questionnaire at a minimum of 5 years after treatment (mean 8.5 years), and full replies were obtained from 39/42 (93%). The long-term outcome was good or excellent in 82%. A history of injury, and the demonstration by MRI or discography of disc degeneration at more than one level was associated with a reduced success rate both at 1 year and in the long term. We conclude that there are no long-term ill effects of chemonucleolysis with chymopapain on the adolescent disc. It is a useful procedure that is well tolerated and we have no reservations about its use.