A review of chymopapain for chemonucleolysis of lumbar disc herniation

The purpose of this review was to examine the available literature regarding the efficacy of chymopapain for chemonucleolysis of symptomatic lumbar disc herniation. Recent literature reviews demonstrate that there are few well-designed studies investigating this once more popular treatment modality. There are two landmark papers published by Couto and Gibson that pool the available data and perform meta-analyses to give reasonable conclusions regarding the efficacy of chymopapain for chemonucleolysis. Based on the meta-analyses, injection of chymopapain into the disc has proven to be more effective than placebo. The results of chemonucleolysis with chymopapain and collagenase are similar. Most randomized trials show consistently poorer results with chymopapain compared with surgery, but the results of themeta-analyses do not reach statistical significance. Therefore, no definitive results can be drawn from the available data. Further research and refinement in this modality will be needed before chymopapain therapy can be recommended for widespread clinical use.