Volume 21, Issue 1 (January 1976)
Two Anaphylactic Deaths After Chemonucleolysis
Prior to the early 1960s, treatment of low back pain ascribed to discogenic disease was a choice between a conservative, nonsurgical regime of rest, physiotherapy, and supportive measures, or laminectomy. In 1963, Smith began to inject the drug chymopapain into lumbar disks in patients with low back pain and sciatica . This procedure is now called chemonucleolysis. The purpose of such injections is to depolymerize the cementing protein of the chondromucoprotein complex, reducing the molecular size and viscosity of the nucleus pulposus, thus chemically decompressing the disk space . Anaphylaxis after the injection of chymopapain has been reported [3–6]. The two cases herein reported, however, are the only known deaths due to anaphylaxis.