earticle

영어

Purpose: Chemonucleolysis is a pioneering technique in spinal surgery that introduces the concept of percutaneous nucleus removal as a minimally invasive spinal intervention. Methods: The procedure involves the injection of nucleus-dissolving agents such as chymopapain through a cannula to induce decompression of the intervertebral disc. Results: Although this method offers advantages in terms of convenience and cost-effectiveness, it presents a major limitation: the inability to control the diffusion range of the injected drug within the nucleus, posing a risk of widespread nuclear degeneration. To address this issue, a technique utilizing a Pluronic-based nanoparticle drug delivery system to restrict the diffusion of chymopapain. Since 2018, Japanese medical practice has replaced chymopapain with condoiase for chemonucleolysis. Although condoliase is a safe drug; it lacks diffusion control technology, leaving concerns regarding potential nuclear degeneration unresolved. Conclusion: This study investigated the technical principles of chemonucleolysis and the mechanisms of controlled drug diffusion delivery systems in chymopapain-based procedures. It also critically evaluated whether the adoption of condoliase in recent chemonucleolysis practices in Japan aligns with the ideals of minimally invasive interventions. Additionally, the feasibility of developing innovative delivery systems and procedures that ensure both efficacy and safety in disc decompression is explored, outlining future directions for chemonucleolysis advancements.