After 5 years, no deterioration had occurred, as compared with the 1-year follow-up assessment. Chymopapain has proved to be safe, with one minor anaphylactic reaction, and effective even over the long term. Collagenase may need further study and cannot be recommended at this time.

The effect of sodium chloride solution on disc tissue was investigated in vitro. Tissue material was obtained from 19 discectomies. The specimens were incubated in aqua ad injectionem and in different sodium chloride solutions and weighted regularly during a maximum of 24 hours. Following the incubation periods the specimens were examined histologically. After one hour the surgical specimens showed a weight increase of 290% for aqua bidest., 170% for 0.9% NaCl and 100% for 5.85% NaCl and 10% NaCl. Disc tissue obtained from six autopsies was also examined under the same conditions. The weight increase in nucleus pulposus and anulus fibrosus tissue was less than in the disc tissue obtained from surgery. The weight increase in anulus fibrosus tissue was less than in nucleus pulposus tissue. In vitro incubation of disc tissue in a hypermolar sodium chloride solution always resulted in a weight increase. Successful therapy could not be explained by shrinkage of disc tissue treated with hypermolar sodium chloride.

In a comparative study 71 patients were treated by intradiscal injection of collagenase and 93 patients by chymopapain injections. Indication, technique of injection and post-injection treatment were based on uniform criteria and followed standardised procedure. In practically all cases, monosegmental injections were performed almost exclusively in the last two discs of the lumbar vertebral column; in cases where the x-ray and clinical findings were unequivocal, the injections were performed at one level of the lumbar vertebral column. After collagenase injection, patients suffered more from low back pain, needed higher doses of strong analgesics, and had a longer hospital stay. Results after one year were almost equal with success rates of 75% (chymopapain) and 72% (collagenase). In each group about three-quarters of the patients with unsatisfactory results were operated on.

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