Chemonucleolysis versus laminectomy. A cohort comparison of effectiveness and charges.

STUDY DESIGN A prospective cohort study was done comparing 100 consecutive chemonucleolysis patients with 100 consecutive laminectomy patients. OBJECTIVES The effectiveness and cost of chymopapain chemonucleolysis was compared with that of laminectomy to manage herniated lumbar discs. SUMMARY OF BACKGROUND DATA Although the efficacy of chemonucleolysis has been established, controversy regarding the relative benefits of chemonucleolysis and laminectomy continues to arise. The relative cost-effectiveness of the two procedures has not been evaluated previously in a cohort study. METHODS Patients in both treatment groups were of comparable age, height and weight, and worker's compensation status. Patients with migrated disc were not considered for chemonucleolysis. Improvement in pain, paresthesia, straight-leg raising, reflexes, motor loss, and sensory function, self-reported overall improvement, ability to maintain employment, and charge of treatment were used to measure treatment success. RESULTS Clinical assessment after 6 weeks showed 92% of laminectomy patients compared with 82% of chemonucleolysis patients compared with 82% of chemonucleolysis patients had successful results (P = 0.058). Chemonucleolysis patients had greater improvement in numbness (P = 0.014) and sensory and motor functions (P = 0.002). After 6 months, 88% of chemonucleolysis patients and 85% of laminectomy patients had successful results, with a greater improvement in sensory status of chemonucleolysis patients and 82% of laminectomy patients had successful results, and more chemonucleolysis patients than laminectomy results, the average charge savings for chemonucleolysis patients was +5365 when chemonucleolysis was performed instead of laminectomy. CONCLUSION This study shows that chemonucleolysis is an effective as laminectomy in appropriately selected patients but at lower charge and can contribute substantially to reducing short-and long-term health costs.