Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, South Korea; Department of Acupuncture and Moxibustion Medicine, Korean Medicine Hospital, Pusan National University, Yangsan, South Korea.
Complement Ther Med. 2013 Oct;21(5):535-56. doi: 10.1016/j.ctim.2013.08.007. Epub 2013 Aug 20.
Lumbar spinal stenosis (LSS) negatively affects patients' quality of life. No systematic review evaluating the effects and safety of acupuncture for this population is available. We aimed to evaluate evidence indicating the effectiveness and safety of acupuncture for LSS.
We searched five English-language databases (EMBASE, MEDLINE, CENTRAL, CINAHL, and AMED) and one Chinese database (CAJ) for randomised controlled trials (RCTs) and non-randomised controlled clinical trials (CCTs) of needle acupuncture for LSS. CCTs were analyzed only in terms of safety and intervention-related information.
Six RCTs (n=582) and six CCTs, which were all from China and reported in Chinese, were included. High or uncertain risk of bias and clinical heterogeneity due to different acupuncture techniques were observed. All RCTs compared different combinations or techniques of acupuncture. None of the included studies mentioned safety issues. Acupuncture combined with other interventions and/or with additional stimulation increased the number of improved patients compared with acupuncture alone or relatively simpler stimulation (n=582; relative risk, 1.16; 95% confidence interval 1.08-1.25). Pain intensity, overall symptoms, and functional outcomes related to LSS and quality of life showed significantly favourable improvement in the treatment group compared with the control group, which lasted for up to 6 months post-treatment.
We found no conclusive evidence of the effectiveness and safety of acupuncture for LSS because of high or uncertain risk of bias and the limited generalisability of the included studies. Future trials using rigorous methodology, appropriate comparisons and clinically relevant outcomes should be conducted.
腰椎管狭窄症（LSS）会降低患者的生活质量。目前尚无系统评价评估针灸治疗该人群的效果和安全性。我们旨在评估针灸治疗 LSS 的证据。
我们检索了五个英文数据库（EMBASE、MEDLINE、CENTRAL、CINAHL 和 AMED）和一个中文数据库（CAJ），以查找针对 LSS 的针刺随机对照试验（RCT）和非随机对照临床试验（CCT）。仅对 CCT 进行了安全性和干预相关信息分析。
纳入了 6 项 RCT（n=582）和 6 项 CCT，均来自中国，且均以中文报告。观察到高或不确定的偏倚风险和由于不同的针灸技术导致的临床异质性。所有 RCT 均比较了不同的针刺组合或技术。纳入的研究均未提及安全性问题。与单独针刺或相对简单的刺激相比，针刺结合其他干预措施和/或额外刺激可增加改善患者的数量（n=582；相对风险，1.16；95%置信区间 1.08-1.25）。与对照组相比，治疗组的疼痛强度、整体症状以及与 LSS 相关的功能结局和生活质量均有显著改善，且这种改善持续至治疗后 6 个月。
由于存在高或不确定的偏倚风险，且纳入研究的普遍性有限，我们未发现针灸治疗 LSS 的有效性和安全性的确凿证据。未来的试验应采用严格的方法学、适当的对照和具有临床相关性的结局。
