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[Lumbar disk prolapses and radiological spinal intervention. What do the randomized controlled trials say?]
F O Rasmussen1, T Amundsen, B Vandvik
1Nevrologisk avdeling Medisinsk klinikk Ullevål sykehus, Oslo.
Summary
For lumbar herniated discs, chymopapain injections show some benefit but are less effective than surgery. Automated percutaneous discectomy offers no significant advantage over placebo.
Area of Science:
- Neurosurgery
- Minimally Invasive Procedures
- Spinal Surgery
Background:
- Lumbar herniated discs are a common cause of low back pain.
- Conservative treatments often fail, necessitating surgical or minimally invasive interventions.
- Chymopapain injections and automated percutaneous discectomy are alternative treatments to traditional surgery.
Purpose of the Study:
- To evaluate the efficacy of chemonucleolysis with chymopapain versus surgical discectomy and placebo.
- To assess the effectiveness of automated percutaneous discectomy compared to placebo for lumbar herniated discs.
Main Methods:
- Systematic review and meta-analysis of 11 randomized controlled trials.
- Comparison of outcomes for chymopapain injections, automated percutaneous discectomy, surgical discectomy, and placebo treatments.
Main Results:
- Chemonucleolysis with chymopapain demonstrated efficacy superior to placebo but inferior to surgical discectomy.
- Automated percutaneous discectomy showed no statistically significant efficacy beyond a placebo response in the evaluated trials.
Conclusions:
- Surgical discectomy remains the most effective treatment for lumbar herniated discs when conservative measures fail.
- Chemonucleolysis with chymopapain is a viable, though less effective, alternative to surgery.
- Automated percutaneous discectomy's efficacy is questionable based on current evidence.