What Evidence Exists on Alternative Forms and Techniques of Lumbar Spine Surgery?
• There is strong evidence (Strength A) that surgical discectomy produces better clinical outcomes than chemonucleolysis. • There is moderate evidence (Strength B) that the clinical outcomes of microdiscectomy are comparable with those of standard discectomy. • There is moderate evidence (Strength B) that automated percutaneous discectomy produces poorer clinical results than standard discectomy or chemonucleolysis. • There is no acceptable evidence (Strength D) of laser discectomy. • There is limited and inconclusive evidence (Strength C) on the relative efficacy of different doses of chymopapain, chymopapain compared with collagenase, and collagenase compared with placebo. • It is possible that some form of interposition membrane may produce a slight reduction in the formation of severe scar tissue after discectomy (Strength B). There is moderate evidence that clinical outcomes are unchanged (Strength B) and limited evidence (Strength C) that an interposition membrane does not influe
