Chemonucleolysis with chondroitin sulfate ABC endolyase as a novel minimally invasive treatment for patients with lumbar intervertebral disc herniation

J Spine Surg. 2019 Jun;5(Suppl 1):S115-S121. doi: 10.21037/jss.2019.04.24.


Chemonucleolysis is a minimally invasive treatment for cervical and lumbar intervertebral disc herniation (IDH). While this procedure has existed for more than 50 years, it has yet to become an established practice. The main reason for this is the low specificity of enzymes targeting nucleus pulposus (NP). Although two enzymes (chymopapain and collagenase) have been used in clinical settings, severe adverse events have discouraged widespread use. The recently introduced enzyme Proteus vulgaris chondroitin sulfate ABC endolyase may allow a new era of chemonucleolysis because of its high specificity for NP.

Keywords: Chemonucleolysis; Proteus vulgaris chondroitin sulfate ABC endolyase; intervertebral disc herniation (IDH); minimally invasive.

Publication types

  • Review