SECTIONIV
LETTERS TO THE EDITOR “Reply to ‘Chymopapain-Past
and Present, Future?’
”
The disasters mentioned in Professor Ford‘s letter to the editor constitute a very small risk factor and as has been pointed out a multitude of times the risk of laminectomy, disk excision plus or minus fusion, are much greater than are the risks of chemonucleolysis. The sudden cessation of the availability of chymopapain is tragic. It is hoped that a long term follow-up will be carried out on the 98 patients involved in the 4 double-blind studies carried out in the United States. An independent assessment should be made on possibly 100 of the 15,000 patients who have had chemonucleolysis in order to establish its true worth in the long term. GRAHAM, F.R.C.S.E. C. EDMUND “Oxford Heights” (7th Floor), 253 Oxford Street, Bondi Junction 2002, Sydney, A USTRALIA
Dear Sir: I was most interested to read the letter to the Editor by Lee T. Ford entitled “Chymopapain - Past and Present, Future?”’ Having performed the first double-blind study comparing chemonucleolysis with hydrocortisone2 I thought your readers might be interested in a 4-5-year follow-up that I recently carried out. It is interesting that in the original assessment I obtained about a 50% good or fair result with chymopapain and when reviewed 4-5 years later the same 50% were still good and fair. This, however, was not the case with the patients treated with intradiskal steroid. Of the 50% who were in the good and fair group early on, only one-half of those remained in the good and fair group at the 4-5-year postinjection period. I believe that if the process known as chemonucleolysis can give a good and fair result in 50% of cases then it is certainly worthwhile. I am in the process of having an independent observer assess all my chemonucleolysis patients treated, by me, between 1969 and 1975. In this way the long term effect of chemonucleolysis can be fairly assessed and, if need be, compared to a group of 250 patients who, over a similar period, have been treated with intradiskal steroid.
REFERENCES 1. Ford, L. T.: Chymopapain-Past and Present, Future?, Clh. Orthop. 122:367, 1977.
2. Graham, C. E.: Chemonucleolysis - A double blind study comparing chemonucleolysis with intradiscal hydrocortisone in the treatment of backache and sciatica, Clin. Orthop. 117: 179, 1976. 319
LETTERS TO THE EDITOR “Reply to ‘Chymopapain-Past
and Present, Future?’
”
The disasters mentioned in Professor Ford‘s letter to the editor constitute a very small risk factor and as has been pointed out a multitude of times the risk of laminectomy, disk excision plus or minus fusion, are much greater than are the risks of chemonucleolysis. The sudden cessation of the availability of chymopapain is tragic. It is hoped that a long term follow-up will be carried out on the 98 patients involved in the 4 double-blind studies carried out in the United States. An independent assessment should be made on possibly 100 of the 15,000 patients who have had chemonucleolysis in order to establish its true worth in the long term. GRAHAM, F.R.C.S.E. C. EDMUND “Oxford Heights” (7th Floor), 253 Oxford Street, Bondi Junction 2002, Sydney, A USTRALIA
Dear Sir: I was most interested to read the letter to the Editor by Lee T. Ford entitled “Chymopapain - Past and Present, Future?”’ Having performed the first double-blind study comparing chemonucleolysis with hydrocortisone2 I thought your readers might be interested in a 4-5-year follow-up that I recently carried out. It is interesting that in the original assessment I obtained about a 50% good or fair result with chymopapain and when reviewed 4-5 years later the same 50% were still good and fair. This, however, was not the case with the patients treated with intradiskal steroid. Of the 50% who were in the good and fair group early on, only one-half of those remained in the good and fair group at the 4-5-year postinjection period. I believe that if the process known as chemonucleolysis can give a good and fair result in 50% of cases then it is certainly worthwhile. I am in the process of having an independent observer assess all my chemonucleolysis patients treated, by me, between 1969 and 1975. In this way the long term effect of chemonucleolysis can be fairly assessed and, if need be, compared to a group of 250 patients who, over a similar period, have been treated with intradiskal steroid.
REFERENCES 1. Ford, L. T.: Chymopapain-Past and Present, Future?, Clh. Orthop. 122:367, 1977.
2. Graham, C. E.: Chemonucleolysis - A double blind study comparing chemonucleolysis with intradiscal hydrocortisone in the treatment of backache and sciatica, Clin. Orthop. 117: 179, 1976. 319
