Method of treatment of cervical osteochondrosis by intradiscal administration of small doses of papain: morphological substantiation and clinical application

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Abstract

Experiments in 91 rabbits were performed to study the action of proteolytic enzyme - papaine (lekozime, «Lek», Yugoslavia) in small doses (0.5-1.0 mg) and alcohol (in concentrations 24%, 48%, 96%) on the structure of intervertebral disks. 359 intervertebral disks were examined using light and electron microscopy. Morphologic data showed that under papaine effect the gradual substitution of the hydrated tissue of nucleus pulposus by fibrous tissue, decrease of intervertebral space and formation of not mobile block between two displaced vertebral bodies took place. Data obtained during experiments allowed to apply intradisk injection of papaine in small doses for the treatment of cervical intervertebral disk pathology, and gave the possibility to elaborate new method for the treatment of cervical osteochondrosis. That method was used in 89 patients. Follow-up period ranged from 3 months to 9 years. Positive results preserved in 95.2%o of patients. Indications and contraindications for the application of elaboration method were defined on the base of experimental and clinical data, outcomes and treatment efficacy.

About the authors

S. T. Vetrila

Central Institute of Traumatology and Orthopedics. N.N. Priorova

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, Moscow

T. I. Pogozheva

Central Institute of Traumatology and Orthopedics. N.N. Priorova

Email: info@eco-vector.com
Russian Federation, Moscow

N. I. Styablin

Central Institute of Traumatology and Orthopedics. N.N. Priorova

Email: info@eco-vector.com
Russian Federation, Moscow

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2. Fig. 1. Nucleus pulposus of an intact rabbit intervertebral disc. (a) strands of notochord cells (stained with picrofuchsin. ca. 7, v. 16); b TEM: ultrastructure of a group of notochord cells, poor in cytoplasmic organelles and intercellular contacts of the "castle" type (magnitude 4500); c - TEM: ultrastructure of a single notochord cell with a long cytoplasmic process. The intercellular matrix is represented by a granular-filamentous network of proteoglycans (magnitude 4500); (d) transversely striated filamentous aggregates (CBFA) of the extracellular matrix (magnitude 20,000).

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3. Fig. 2. The structure of the intervertebral disc of a rabbit after the introduction of ethyl alcohol. a — 2 weeks after administration of 48% ethanol (stained with picrofuchsin. Ok. 7, vol. 3); b — 1 month after the introduction of 96% ethanol (ca. 7, v. 10).

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4. Fig. 3. The nucleus pulposus of a rabbit after a single injection of 0.5 mg of papain. a — disintegration of cell strands 1 hour after the administration of papain (stained with picrofuchsin. ok. 7, v. 20); b — TEM: a group of notochord cells with hydropic vacuoles and a dense nucleus 1 hour after the administration of papain (magnitude 4500); (c) TEM: accumulation of granular material containing glycosaminoglycans secreted by the notochord cell in the pericellular zone 24 hours after papain administration (magn. 20,000); d — TEM: newly formed collagen fibrils in the pericellular zone of the fibroblast 14 days after the administration of papain (magnitude 20,000); e — cellular fibrous tissue that replaced the nucleus pulposus, 1 month after the administration of papain (stained with picrofuchsin, Ok. 7, v. 16); f — the structure of the intervertebral disc of a rabbit 1 month after the administration of papain (stained with picrofuchsin. Ok. 7, v. 3).

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