Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej 18-22, DK 9000, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Soender Skovvej 15, DK 9000, Aalborg, Denmark.
Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej 18-22, DK 9000, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Soender Skovvej 15, DK 9000, Aalborg, Denmark.
Spine J. 2021 Oct;21(10):1750-1762. doi: 10.1016/j.spinee.2021.02.022. Epub 2021 Mar 3.
Implants for use in disc herniation surgery have been commercially available for some time. Several clinical trials have shown promising results. There are now a wide variety of surgical methods for treating lumbar disc herniation.
The objective of this systematic review was to compare all current surgical methods for disc herniation, including newer methods with implants for annulus repair and dynamic stabilization.
Systematic review and network meta-analysis.
PRISMA-P guidelines were followed in this review. Literature search in PubMed, Embase, and Cochrane library databases identified eligible randomized controlled trials (RCT) studies comparing interventions for lumbar disc surgery. The investigated outcomes were: changes in pain score, disability score and reoperation rate with a minimum follow-up of 1 year. Risk of bias was assessed in concordance with Cochrane Neck and Back Review Group recommendation. A network meta-analysis was performed using gemtc and BUGSnet software, and each outcome evaluated using Confidence in Network Meta-Analysis (CINeMA).
Thirty-two RCT studies, with 4,877 participants, and eight different interventions were identified. A significant difference was seen in change of pain score, as all treatments were superior to conservative treatment and percutaneous discectomy. This difference was only found to be of clinically importance when comparing conservative treatment and dynamic stabilization. There was no significant difference in reoperation rates or change in disability score, regardless of treatment. However, SUCRA plots showed a trend in ranking annulus repair and dynamic stabilization highest. Risk of bias assessment showed that 15 studies had a high overall risk of bias. Meta-regression with risk of bias as covariate did not indicate any influence in risk of bias on the model. Confidence in Network Meta-Analysis evaluation showed a high level of confidence for all treatment comparisons.
With this network meta-analysis, we have aimed to compare all treatments for herniated lumbar disc in one large comprehensive systematic review and network meta-analysis. We have compared across the three main outcomes: disability score, pain score and reoperation rate. We were not able to rank one single treatment as the best. Most of the treatment performed at the same level. However percutaneous discectomy and conservative treatment consistently performed worse than the other treatments. In general, the CINeMA evaluation according to the GRADE recommendations gave a high level of confidence for the study comparisons.
用于椎间盘突出症手术的植入物已经商业化一段时间了。几项临床试验显示出了有前景的结果。目前有多种治疗腰椎间盘突出症的手术方法。
本系统评价的目的是比较所有目前的椎间盘突出症手术方法，包括使用环修复和动态稳定植入物的新方法。
系统评价和网络荟萃分析。
本研究遵循 PRISMA-P 指南。在 PubMed、Embase 和 Cochrane 图书馆数据库中进行文献检索，确定了比较腰椎手术干预措施的合格随机对照试验 (RCT) 研究。研究的结果是：疼痛评分、残疾评分和 1 年以上随访的再手术率的变化。根据 Cochrane 颈腰痛综述组的建议评估偏倚风险。使用 gemtc 和 BUGSnet 软件进行网络荟萃分析，使用置信网络荟萃分析 (CINeMA) 评估每个结果。
确定了 32 项 RCT 研究，共 4877 名参与者和 8 种不同的干预措施。所有治疗方法都优于保守治疗和经皮椎间盘切除术，在疼痛评分的变化方面有显著差异。只有在比较保守治疗和动态稳定时，这种差异才具有临床意义。再手术率或残疾评分的变化没有差异，无论治疗方法如何。然而，SUCRA 图显示出对环修复和动态稳定的最高排名趋势。偏倚风险评估显示，15 项研究整体偏倚风险较高。以偏倚为协变量的元回归分析表明，偏倚对模型没有影响。置信网络荟萃分析评估显示，所有治疗比较的置信度都很高。
通过这项网络荟萃分析，我们旨在比较一个大型综合系统评价和网络荟萃分析中的所有治疗腰椎间盘突出症的方法。我们比较了三个主要结果：残疾评分、疼痛评分和再手术率。我们无法将一种单一的治疗方法列为最佳。大多数治疗方法的效果相同。然而，经皮椎间盘切除术和保守治疗的效果始终不如其他治疗方法。总的来说，根据 GRADE 建议的 CINeMA 评估对研究比较给予了高度信任。
