This report is the first update of the systematic reviews "Chemonukleolyse und intradiskale Elektrotherapie" and "Perkutane Nukleotomie und perkutane Laserdiskusdekompression" compiled in 2009. The review investigates the efficacy and safety of the procedures, with particular focus on chemonucleolysis. These minimally invasive surgical procedures are used for the treatment of back pain and provide a treatment alternative to surgery.

Current evidence suggests a benefit in efficacy for O2-O3-nucleolysis when compared to steroid injections alone with no difference regarding safety. In addition it appears to be equal in efficacy and safety compared to disc surgery. To date, there are no placebo-controlled trials available however. For chemonucleolysis with chymopapain and condoliase no recommendations were made, since these substances were either withdrawn from sale or have no current regulatory approval. For all other three interventions no significant new controlled studies have been identified since the previous reports in 2009.