腰痛的非手术介入治疗：美国疼痛学会临床实践指南的证据综述

Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline.

作者信息

Chou Roger, Atlas Steven J, Stanos Steven P, Rosenquist Richard W

机构信息

Department of Medicine, Oregon Evidence-Based Practice Center, Oregon Health and Science University, Portland, OR, USA.

出版信息

Spine (Phila Pa 1976). 2009 May 1;34(10):1078-93. doi: 10.1097/BRS.0b013e3181a103b1.

DOI:10.1097/BRS.0b013e3181a103b1

PMID:19363456

Abstract

STUDY DESIGN

Systematic review.

OBJECTIVE

To systematically assess benefits and harms of nonsurgical interventional therapies for low back and radicular pain.

SUMMARY OF BACKGROUND DATA

Although use of certain interventional therapies is common or increasing, there is also uncertainty or controversy about their efficacy.

METHODS

Electronic database searches on Ovid MEDLINE and the Cochrane databases were conducted through July 2008 to identify randomized controlled trials and systematic reviews of local injections, botulinum toxin injection, prolotherapy, epidural steroid injection, facet joint injection, therapeutic medial branch block, sacroiliac joint injection, intradiscal steroid injection, chemonucleolysis, radiofrequency denervation, intradiscal electrothermal therapy, percutaneous intradiscal radiofrequency thermocoagulation, Coblation nucleoplasty, and spinal cord stimulation. All relevant studies were methodologically assessed by 2 independent reviewers using criteria developed by the Cochrane Back Review Group (for trials) and by Oxman (for systematic reviews). A qualitative synthesis of results was performed using methods adapted from the US Preventive Services Task Force.

RESULTS

For sciatica or prolapsed lumbar disc with radiculopathy, we found good evidence that chemonucleolysis is moderately superior to placebo injection but inferior to surgery, and fair evidence that epidural steroid injection is moderately effective for short-term (but not long-term) symptom relief. We found fair evidence that spinal cord stimulation is moderately effective for failed back surgery syndrome with persistent radiculopathy, though device-related complications are common. We found good or fair evidence that prolotherapy, facet joint injection, intradiscal steroid injection, and percutaneous intradiscal radiofrequency thermocoagulation are not effective. Insufficient evidence exists to reliably evaluate other interventional therapies.

CONCLUSION

Few nonsurgical interventional therapies for low back pain have been shown to be effective in randomized, placebo-controlled trials.

摘要

研究设计

系统评价。

目的

系统评估非手术介入疗法治疗下腰痛和神经根性疼痛的益处和危害。

背景数据总结

尽管某些介入疗法的使用很普遍或呈增加趋势，但关于其疗效仍存在不确定性或争议。

方法

通过检索Ovid MEDLINE和Cochrane数据库，截至2008年7月，以识别关于局部注射、肉毒杆菌毒素注射、注射疗法、硬膜外类固醇注射、小关节注射、治疗性内侧支阻滞、骶髂关节注射、椎间盘内类固醇注射、化学髓核溶解术、射频去神经术、椎间盘内电热疗法、经皮椎间盘内射频热凝术、等离子体消融髓核成形术和脊髓刺激的随机对照试验和系统评价。所有相关研究均由2名独立评审员根据Cochrane背部综述小组（针对试验）和Oxman（针对系统评价）制定的标准进行方法学评估。使用美国预防服务工作组改编的方法对结果进行定性综合分析。

结果

对于坐骨神经痛或伴有神经根病的腰椎间盘突出症，我们发现充分证据表明化学髓核溶解术略优于安慰剂注射，但不如手术；中等证据表明硬膜外类固醇注射对短期（而非长期）症状缓解有一定效果。我们发现中等证据表明脊髓刺激对伴有持续性神经根病的腰椎手术失败综合征有一定效果，尽管与设备相关的并发症很常见。我们发现充分或中等证据表明注射疗法、小关节注射、椎间盘内类固醇注射和经皮椎间盘内射频热凝术无效。没有足够的证据可靠地评估其他介入疗法。