Chemonucleolysis (Discolysis) with Collagenase

CT-Guided Chemonucleolysis Combined with Psoas Compartment Block in Lumbar Disc Herniation: A Randomized Controlled Study

“…Postoperative pain of collagenase injection has been reported in many studies [10,22,23]. Brown et al [24] theorized that the postoperative pain is the result of a breakdown in the collagen fibers of the nucleus pulposus, thus allowing increased swelling pressure of the disc matrix, causing secondary chemical radiculitis.…”

The Use of Intralesional Clostridial Collagenase Injection Therapy for Peyronie's Disease: A Prospective, Single-Center, Non-Placebo-Controlled Study

“…Although in the majority of these reports, collagenase yielded good results (78-80% success) and was well tolerated with few complications, no laboratory abnormalities, or allergic or other toxic or infectious manifestations [9][10][11]; in one report, 8 of 11 cases were considered failures, with findings consistent with damage to adjacent normal structures [12]. The results of this report caused the FDA to temporarily halt clinical trials with collagenase [11]; however, research was later permitted to resume, and subsequent trials demonstrated the safety and efficacy of intervertebral collagenase injections for treatment of herniated lumbar disks in properly selected patients [13,14]. In 1982, a pilot study designed to test the feasibility of using purified clostridial collagenase in the clinical management of Peyronie's disease demonstrated collagenase injections reduced Peyronie's plaque fragments without damage to surrounding elastic tissue, vascular smooth muscle, or axon myelin sheaths [15].…”

Five-Year Results From Chemonucleolysis With Chymopapain or Collagenase

“…The clinical experience with collagenase started in the early 1980s, with success rates between 69% and 88%. 9,10,12,17,36,40 Results from a randomized double-blind dose-finding study of 20 versus 450 ABC units of collagenase in 85 patients showed a significant pain improvement in 76% of the high-dose group, as compared with 54% of the low-dose group. 62 These comparisons with other studies are as interesting as the development of the clinical outcome over 5 years for both enzymes.…”

“…9 There were no reports about allergic reactions or sensitivity to collagenase, but endplate erosions of the adjacent vertebra, mimicking the picture of discitis, were reported. 10,12,36,39,40 Even 7 to 10 times the therapeutic dose injected into the disc or intravenously in dogs and monkeys caused no toxic effects. 8,69 After intrathecal injections of lower doses in dogs, anterior horn cell degenerations were seen.…”

“…5,20,75 More serious complications have been lumbar subarachnoid hemorrhage and paraplegia. 2,12 Experimental investigations have shown that peripheral and intrathecal injection result in the clinically described changes. 49,50,55 Because of improved and more controlled injection techniques, these complications have not occurred at all since 1987.…”