[Cause of failure of nucleolysis and results of surgery].

Out of a total of 435 cases of nucleolysis, 400 case-reports of which could be used, secondary surgery was performed in 48 cases or 12% of the total. Surgery was most frequently required following L4/L5 than L5/S1 nucleolysis. The most frequent causes of failure of nucleolysis were lateral osseous stenosis (19 cases) and sub-ligamentous hernia (17 cases), apparently due to the ineffectiveness of the enzyme. Excluded hernia was rare (4 cases). Hernias at another level (4 cases) required surgery since it was not possible to repeat the injection of chymopapain. Three of these explorations were of the linea alba and one failure was due to spondylolisthesis due to isthmic lysis. Some failures occurred after some delay. The sciatic relapses after a period of complete clinical cure. In some cases, the relapse was in fact at another level or involved sub-ligamentous or excluded hernia. Surgery following nucleolysis is the same as that of an uninjected hernia; there are no adherences. The results are generally the same as those obtained by primitive surgery (two thirds favorable outcome). However, this depends mainly on what has been detected. The results are very good for hernias at another level and for excluded hernias. Fair results are obtained for stenosis and for sub-ligamentous hernias but only poor results in explorations of the linea alba.