Dural puncture using the lateral approach for chemonucleolysis

The lateral approach for chemonucleolysis was developed to avoid dural puncture, which occurs with midline and posterolateral approaches. It is important to check for dural punctures during the procedure. If the dura is penetrated, a potential pathway is created for chymopapain to enter the subarachnoid space. Large doses of intrathecal chymopapain are highly toxic and small doses show a variable response. Because of the potential disastrous complications associated with intrathecal chymopapain, the chymopapain injection is contraindicated in the presence of a dural leak.