Lumbar disk prolapses and radiological spinal intervention. What do the randomized controlled trials say?

We searched the Medline database and examined 11 randomized controlled trials to evaluate the efficacy of treating lumbar herniated discs by injection with chymopapain or by automated percutaneous discectomy. Our findings show that chemonucleolysis with chymopapain is a documented treatment which is better than placebo, but consistently inferior to surgical discectomy. The two randomized controlled trials to evaluate automated percutaneous discectomy fail to show efficacy that is any better than would be expected from a placebo response. We conclude that surgical discectomy is the best treatment option for a herniated disc when conservative efforts have failed.