Manchikanti Laxmaiah, Knezevic Emilija, Knezevic Nebojsa Nick, Sanapati Mahendra R, Kaye Alan D, Thota Srinivasa, Hirsch Joshua A
Pain Management Centers of America, Paducah, KY & Evansville, IN, USA.
University of Illinois at Urbana-Champaign, College of Liberal Arts and Sciences, Champaign, IL, USA.
Korean J Pain. 2021 Jul 1;34(3):346-368. doi: 10.3344/kjp.2021.34.3.346.
Recalcitrant disc herniation may result in chronic lumbar radiculopathy or sciatica. Fluoroscopically directed epidural injections and other conservative modalities may provide inadequate improvement in some patients. In these cases, percutaneous neurolysis with targeted delivery of medications is often the next step in pain management.
An evidence-based system of methodologic assessment, namely, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. Multiple databases were searched from 1966 to January 2021. Principles of the best evidence synthesis were incorporated into qualitative evidence synthesis. The primary outcome measure was the proportion of patients with significant pain relief and functional improvement (≥ 50%). Duration of relief was categorized as short-term (< 6 months) and long-term (≥ 6 months).
This assessment identified one high-quality randomized controlled trial (RCT) and 5 moderate-quality non-randomized studies with an application of percutaneous neurolysis in disc herniation. Overall, the results were positive, with level II evidence.
Based on the present systematic review, with one RCT and 5 nonrandomized studies, the evidence level is II for percutaneous neurolysis in managing lumbar disc herniation.
顽固性椎间盘突出症可能导致慢性腰神经根病或坐骨神经痛。在某些患者中，透视引导下的硬膜外注射和其他保守治疗方法可能改善效果不佳。在这些情况下，靶向给药的经皮神经松解术通常是疼痛管理的下一步措施。
采用一种基于证据的方法学评估系统，即系统评价和荟萃分析的首选报告项目（PRISMA）。检索了1966年至2021年1月的多个数据库。最佳证据合成原则被纳入定性证据合成。主要结局指标是疼痛显著缓解和功能改善（≥50%）的患者比例。缓解持续时间分为短期（<6个月）和长期（≥6个月）。
该评估确定了一项高质量的随机对照试验（RCT）和5项中等质量的非随机研究，这些研究应用了经皮神经松解术治疗椎间盘突出症。总体而言，结果是积极的，具有II级证据。
基于目前的系统评价，包括1项RCT和5项非随机研究，经皮神经松解术治疗腰椎间盘突出症的证据级别为II级。
