Treatment of sciatica. A comparative survey of complications of surgical treatment and nucleolysis with chymopapain.

Chymopapain in the treatment of sciatica by chemonucleolysis has become widespread in the United States and Europe since the approval of this drug for general use by the Food and Drug Administration. Potentially, the increased use of this drug by surgeons with relatively little experience could be expected to cause an increase in the complication rate. This report analyzes the results of a questionnaire sent to surgeons in 316 departments who have recently treated a total of 43,662 patients with this technique. The complication rate was 3.7% (1606 incidents). Of these, 192 (0.45%) were severe. The study revealed that the frequency of severe allergic reactions is lower in Europe than in the United States. Twice the number of anaphylactic reactions occurred with local and neuroleptic anesthesia compared to local or general anesthesia alone. The risk of infectious discitis is low, but a strict sterile technique is mandatory. Neurologic complications were rare, but included 15 cauda equina, one meningeal hemorrhage, a case of epilepsy, and two cases of paraplegia. The rate of complications in this study is comparable to two previous studies; thus, the expected increase in complications has not occurred. For comparison, a survey of 2051 patients treated surgically showed a complication rate of 26% (534 incidents), including 86 (4.2%) severe complications. Among the surgically treated patients, there was a perioperative complication rate of 9.75% (200 incidents) and a postoperative complication rate of 14% (290 incidents), resulting in three deaths. Thus, the surgical treatment was responsible for six times the number of incidents and ten times more severe incidents than for patients treated by nucleolysis.