Diagnostic and therapeutic technology assessment. Chemonucleolysis for herniated lumbar disk.

The DATTA panelists did not achieve a definitive consensus on the use of chymopapain chemonucleolysis for a protruding lumbar disk contained by the annulus. Concerns about safety, especially the risk of anaphylaxis and the risk of damage to the spinal cord, were frequent. The effectiveness of this procedure for this indication was also questioned by many of the panelists. The panel did agree that chemonucleolysis is unacceptable as either safe or effective for use in patients with a herniated lumbar disk that is extruding nucleus pulposus through the annulus. Accordingly, diagnostic imaging of any suspect disk must be performed before chemonucleolysis can be deemed appropriate for any individual patient. Current imaging techniques are not infallible and cannot confer an absolute sense of security when seeming to indicate a nonextruded protruding disk.