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There are few reports of hemorrhagic central nervous system complications after chymopapain injection in humans. Two patients are reported who developed hemorrhagic complications after the lumbar injection of chymopapain. The first developed a hemorrhagic encephalomyelopathy followed by clinically
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Subarachnoid hemorrhage is a frequent finding in patients who have incurred neurological complications following chymopapain chemonucleolysis, but the basis for this occurrence remains controversial. The authors report the clinical and postmortem findings in a 42-year-old man who died 5 days after
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A case of multiple cerebral hemorrhages following chymopapain chemonucleolysis is reported. The authors believe the probable etiology was intrathecal extravasation of chymopapain after injection of the drug into a lumbar disc space.
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In the first of a two-part study, the authors review the known biochemical, pharmacological, toxicological, and experimental data concerning chymopapain and the intervertebral disc. They describe the action of this proteolytic enzyme, which apparently disrupts the protein mucopolysaccharide
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This study was undertaken to clarify the effects of topically injected chymopapain on the spinal cord and peripheral nerves in rabbits, and also the effect of ganglioside on sciatic nerves which had been damaged by chymopapain. There were no abnormal macroscopic or microscopic findings when
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The median lethal dose (LD50) of chymopapain B in mice was 82 mg/kg (22,000 units/kg) with 95% confidence limits of 75-90 mg/kg (20, 122-24, 146 units/kg) and in rats 92 (24,683 units/kg) with 95% confidence limits of 83-102 mg/kg (22,268-27, 366 units/kg). The mechanism of toxicity was hemorrhage
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Using magnetic resonance imaging, conventional histology, and spinal evoked potentials, the authors studied the short-term effects of chymopapain on nerve tissue in the lumbar vertebral canal region in rats. Chymopapain in different concentrations was injected into the subarachnoid space in 31 rats.
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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
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A case report of inadvertent chymopapain introduction into the lumbar theca is reported. It led to an extensive subarachnoid and subdural hemorrhage, producing paraplegia. The neurotoxicity of chymopapain in the experimental model is reviewed and related to a clinical setting. Clinically speaking,
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A spinal cord injury model is described using chymopapain as a neurotoxic agent in rats. The trauma was evaluated by neurophysiological and morphological methods. Electrically evoked compound action potentials were used to quantify the neurophysiological effects caused by the injection of
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On the occasion of my retirement as head of the Neurochirurgische Universitätsklinik Zürich on 31. May 2007, the changing aspects of neurosurgery in diseases dealt with and in their treatments during the last 70 years (from the foundation of the department by Prof. Krayenbuehl in 1937 successed by
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This survey covers 121 "serious" and "unexpected" adverse events after treatment with chymodiactin (chymopapain for injection) among approximately 135,000 patients in the United States. They were reported to the Food and Drug Administration (FDA) within 15 days of notification of the manufacturer
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Even with a history of controversy and troubling complications, chymopapain has endured the test of time to show 30 years of clinical success in the treatment of herniated nucleus pulposus. Strict attention to indications, contraindications, and technique ensures safety and efficacy of treatment. A
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