Back Pain Cure: Chemonucleolysis?

Q: I had a surgery which my doctor called a chymopapain injection in September, 1983. I had ruptured L4/5-S1 in an accident and could not walk because of the constant, electric-shock pain in my left leg. When the time came for the surgery I was given a pre-op and a nerve block just above the site of the injection. I was bent over a folded operating table, and draped for modesty. Can anyone can feel modest in an operating room with a half dozen women in it, plus the doctor, while their bare butt is sticking 4 feet in the air?! I also remember feeling cold. Even though the procedure had been very thoroughly explained to me I was pretty nervous about it. It was not all that bad, in reality. The procedure was done with me fully awake. The doctor needed me to tell him if the needle deviated from the planned path, into a nerve. It actually did a few times, and I felt a slightly painful tingle in the corresponding part of my leg which that nerve went to. The process was slow going. He would move the needle in slightly, have an x-ray taken, compare it to the fluoroscopic (I guess that's what it was) monitor and move a bit more. When the needle was right where he wanted it, he slowly injected the chemical into my disk. The chemical was a digestive enzyme derived from the papaya fruit! People with digestive disorders take it as a supplement to aid in digestion. Some 'geniuses' figured why not let the stuff "digest" the middle out of a ruptured disk so the protruding outer shell would pull back and stop bothering the nerve root. He would inject a little bit and wait a few minutes and then put in some more. He said he was injecting it that way (slowly) because there had been a few reports of anaphylactic shock due to an allergic reaction to the chemical in a small percentage of patients. In fact I had to sign a release form before the surgery stating that I had been advised that there was a possibility of allergic reaction which might include death! I had read up on it somewhat before the surgery and felt that the odds weren't all that bad. I don't remember now what the odds were, but I survived. So far. The chemical dissolved the gooey middle of the ruptured disk so that the protruding outer part pulled back from the nerve root. Then the pain, the tingling and the shocks stopped. I was able to walk with in 2 weeks without any nerve tingle or pain! The doctor had warned me to expect some soreness and burning. I have a fairly strong burning sensation for a month or so but the pain meds covered it for the most part. I was better than I was before I got hurt. The improvement lasted for several years. I later developed arthritis in the area which I am told is common both to my age, 55, and to joint injuries in general. I guess I would have to say that overall the injection was successful. I had a faster recovery time than for some other types of surgeries. At the time my only other option (or so I was told) was a full fusion. From what I had read about full fusions back then, I wanted no part of that option. My surgery was almost 20 years ago. I would hope that many improvements have been made and that your experience would be much better overall. If you do elect to have it done, please write and let me know how yours went. I wish you a full recovery whatever you choose to do. ...And no pain with it.

A: I am not sure if they are still performing this proceedure that much any more, I know that it used to be popular. Now people are performing IDET or microdiscectomies more often for herniated discs. Stick with your doctor, ask lots of questions and always get a second opinion before surgery. Seven weeks is not a lot of time for healing beleive it or not. You still have a window in which to recover. Remember that the discs may very well be the source of your pain but there is the possibility that they are false positives and actually were there before you fell!!!! The main concern is the nerve roots and how much leg weakness you have. If there is significant weakness for a prolonged period then they may want to take the pressure off. If there is no leg weakness then there is much more leeway. You can try different things if the pain is unbearable, including an epidural. What is SpineCATH IDET Therapy? With age, or due to injury, cracks or fissures may develop fissure in the wall of the intervertebral disc. Filled with small nerve endings and blood vessels, these fissures are a chronic source of pain in many patients. Additionally, the inner disc tissue (nucleus) herniated will frequently bulge disc (herniate) into these fissures in the outer region of the disc, likewise stimulating pain sensors within the disc. SpineCATH IDET therapy is a minimally invasive treatment in which the physician applies controlled levels of thermal energy (heat) to a broad section of the affected disc wall. This heat contracts and thickens the collagen of the disc wall, and raises the temperature of the nerve endings. Therapy may result in contraction or closure of the disc wall fissures, a reduction in the bulge of the inner disk material, and a desensitization of the pain sensors within the disc. Who May Benefit from SpineCATH IDET Therapy? SpineCATH IDET therapy acts exclusively upon the tissues of the disc itself, and should not be expected to relieve symptoms arising from other spinal structures, such as nerve roots or spinal joints. It is therefore very important for your physician to diagnose that the disc is the primary source of your back pain. In addition to a clinical examination, your physician may use Magnetic Resonance Imaging (MRI) or injections of dye into the disc (discography) to confirm the diagnosis. Once satisfied that one or more discs are the primary source of your lower back pain, your physician may recommend SpineCATH IDET therapy. The Procedure SpineCATH IDET therapy is usually performed on an outpatient basis. Local anesthesia and mild sedation may be used to reduce discomfort during the procedure. You will be awake and alert so that you can provide important feedback to the physician. With the guidance of x-ray images, your physician will advance a needle into the disc. The SpineCATH catheter will be passed through the needle and into the disc. Once it is in the appropriate position, the temperature of the heating section of the catheter will be gradually increased, raising the disc wall temperature. During the heating protocol, your physician will monitor your condition and comfort level closely. You will most probably feel a reproduction of your usual lower back pain. This is a strong indication that the heat is being applied to the appropriate areas. Once the therapy is completed, the catheter and needle are removed, and you will likely be sent home with a Band-Aid over the needle insertion site. After the Procedure The discomfort generated when the disc is heated may take several days to subside, and your physician may prescribe medication. During the disc healing process, up to 12 to 16 weeks following the procedure, it is very important to treat your discs with care. Your physician will provide you with activity and physical rehabilitation guidelines. Studies have shown that it is during this time that most patients begin to experience relief from their lower back pain symptoms, a reduction or elimination of any medication use, and an increase in their functional abilities. Improvements may continue up to six months following the procedure. Important Information About SpineCATH IDET Therapy SpineCATH IDET therapy, like any surgical procedure, has some risks. Not all patients will find relief for their back pain and relieved symptoms may recur over time. Please consult your physician about the risks and potential complications of SpineCATH IDET therapy. Many additional factors may prevent your physician from recommending SpineCATH IDET therapy for your condition. Such factors may include, but are not limited to, very narrow disc height, severe disc herniation, spinal instability, very advanced stages of disc degeneration, or various general health concerns. If SpineCATH IDET therapy is recommended for you, we advise you to openly discuss your treatment expectations with your physician, as he or she is best suited to ensure your expectations are reasonable given your personal condition.

Back Pain Cure: Chemonucleolysis?

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