The rise and fall of chemonucleolysis

The past four decades have witnessed the arrival of numerous interventional procedures for the treatment of sciatica and back pain. Some have failed to gain general acceptance and have simply faded away, and others continue to be used without evidence of efficacy. What is unique about chymopapain is that it has fallen out of favor despite convincing evidence of its utility and efficacy in the treatment of sciatica from lumbar disc protrusion. It has been shown to be superior to placebo in no less than three double-blind, randomized controlled trials (1,2), and to be cost-effective with low morbidity when compared with open surgery (3).