Daste Camille, Laclau Stéphanie, Boisson Margaux, Segretin François, Feydy Antoine, Lefèvre-Colau Marie-Martine, Rannou François, Nguyen Christelle
Université de Paris, Faculté de Santé, UFR de Médecine de l'Université de Paris, Paris, France.
AP-HP.Centre-Université de Paris, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Paris, France.
Ther Adv Musculoskelet Dis. 2021 Jul 16;13:1759720X211028001. doi: 10.1177/1759720X211028001. eCollection 2021.
We aim to evaluate the benefits and harms of intervertebral disc therapies (IDTs) in people with non-specific chronic low back pain (NScLBP).
We conducted a systematic review and meta-analysis of randomized trials of IDTs placebo interventions, active comparators or usual care. EMBASE, MEDLINE, CENTRAL and CINHAL databases and conference abstracts were searched from inception to June 2020. Two independent investigators extracted data. The primary outcome was LBP intensity at short term (1 week-3 months), intermediate term (3-6 months) and long term (after 6 months).
Of 18 eligible trials (among 1396 citations), five assessed glucocorticoids (GCs) IDTs and were included in a quantitative synthesis; 13 assessed other products including etanercept ( = 2), tocilizumab ( = 1), methylene blue ( = 2), ozone ( = 2), chymopapaine ( = 1), glycerol ( = 1), stem cells ( = 1), platelet-rich plasma ( = 1) and recombinant human growth and differentiation factor-5 ( = 2), and were included in a narrative synthesis. Standardized mean differences (95% CI) for GC IDTs for LBP intensity and activity limitations were -1.33 (-2.34; -0.32) and -0.76 (-1.85; 0.34) at short term, -2.22 (-5.34; 0.90) and -1.60 (-3.51; 0.32) at intermediate term and -1.11 (-2.91; 0.70) and -0.63 (-1.68; 0.42) at long term, respectively. Odds ratios (95% CI) for serious and minor adverse events with GC IDTs were 1.09 (0.25; 4.65) and 0.97 (0.49; 1.91).
GC IDTs are associated with a reduction in LBP intensity at short term in people with NScLBP. Positive effects are not sustained. IDTs have no effect on activity limitations. Our conclusions are limited by high heterogeneity and a limited methodological quality across studies.
PROSPERO: CRD42019106336.
我们旨在评估椎间盘治疗（IDTs）对非特异性慢性下腰痛（NScLBP）患者的益处和危害。
我们对IDTs与安慰剂干预、活性对照或常规治疗的随机试验进行了系统评价和荟萃分析。检索了EMBASE、MEDLINE、CENTRAL和CINHAL数据库以及会议摘要，检索时间从数据库创建至2020年6月。两名独立研究人员提取数据。主要结局是短期（1周 - 3个月）、中期（3 - 6个月）和长期（6个月后）的腰痛强度。
在1396篇被引文献中的18项合格试验中，5项评估了糖皮质激素（GCs）IDTs并纳入定量合成分析；13项评估了其他产品，包括依那西普（n = 2）、托珠单抗（n = 1）、亚甲蓝（n = 2）、臭氧（n = 2）、木瓜凝乳蛋白酶（n = 1）、甘油（n = 1）、干细胞（n = 1）、富血小板血浆（n = 1）和重组人生长分化因子 - 5（n = 2），并纳入叙述性合成分析。GCs IDTs在短期、中期和长期时，腰痛强度和活动受限的标准化均数差（95%CI）分别为 - 1.33（ - 2.34； - 0.32）和 - 0.76（ - 1.85；0.34）、 - 2.22（ - 5.34；0.90）和 - 1.60（ - 3.51；0.32）、 - 1.11（ - 2.91；0.70）和 - 0.63（ - 1.68；0.42）。GCs IDTs发生严重和轻微不良事件的比值比（95%CI）分别为1.09（0.25；4.65）和0.97（0.49；1.91）。
GCs IDTs与NScLBP患者短期腰痛强度降低有关。积极效果不能持续。IDTs对活动受限无影响。我们的结论受到研究间高度异质性和有限的方法学质量的限制。
PROSPERO：CRD42019106336
