不同硬膜外注射方法治疗腰骶神经根性疼痛的比较效果：系统评价和网络荟萃分析。

Comparative Effects of Different Epidural Injection Approaches on Lumbosacral Radicular Pain: A Systematic Review and Network Meta-analysis.

机构信息

Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China.

Department of Orthopaedics, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China.

出版信息

Pain Physician. 2022 Nov;25(8):531-542.

PMID:36375181

Abstract

BACKGROUND

Lumbar disc herniation (LDH) is the main cause of low back pain and/or radiculopathy. Currently, epidural intervention is a widely used and effective conservative treatment method for managing low back and radicular pain caused by LDH.

OBJECTIVES

To explore the effectiveness of different epidural injection approaches in adult patients with lumbosacral radicular pain.

STUDY DESIGN

Systematic review and network meta-analysis (NMA).

METHODS

An electronic literature search was performed in the Pubmed, Embase, Cochrane Library, and Web of Science databases. Two authors independently performed data extraction and quality assessment. A Bayesian random effects model was conducted to incorporate the estimates of direct and indirect treatment comparisons and rank the interventions in order. Effect estimates from Bayesian NMA were presented as mean difference (MD) with 95% credible intervals (CrI).

RESULTS

This NMA assessed caudal (C), interlaminar (IL), transforaminal (TF) and parasagittal interlaminar (PIL) epidural injection approaches for lumbosacral radicular pain from 7 trials. A statistically significant treatment difference for pain relief was reported for midline interlaminar (MIL) vs PIL (MD, 1.16; 95%CrI, 0.31-2.06), MIL vs TF (MD, 1.12; 95%CrI, 0.51-1.85), C vs TF (MD, 1.07; 95%CrI, 0.01-2.18) in short-term follow-up and MIL vs TF (MD, 1.8; 95% CrI, 0.3-3.48) in intermediate-term follow-up. For functional improvement, a statistically significant difference was observed with MIL vs PIL (MD, 9.9; 95% CrI, 0.64-19.94) and MIL vs TF (MD, 1.08; 95% CrI, 1.08-17.08) in short-term follow-up. Moreover, the PIL approach and TF appeoach were ranked in the top 2 for pain relief and functional improvement, both in short-term and intermediate-term follow-up.

LIMITATIONS

The number of studies included was small; 2) some treatments lacked direct comparisons; 3) only scores from the visual analog scale for pain and the Oswestry Disability Index were included in the result; 4) important outcomes, such as complications, were not included.

CONCLUSION

In short-term and intermediate-term follow-up, the PIL approach has the highest probability for pain relief and functional improvement.

摘要

背景

腰椎间盘突出症（LDH）是腰痛和/或神经根病的主要原因。目前，硬膜外介入是治疗由 LDH 引起的腰痛和神经根痛的一种广泛使用且有效的保守治疗方法。

目的

探讨不同硬膜外注射方法在治疗腰骶神经根痛成人患者中的疗效。

研究设计

系统评价和网络荟萃分析（NMA）。

方法

在 Pubmed、Embase、Cochrane 图书馆和 Web of Science 数据库中进行电子文献检索。两名作者独立进行数据提取和质量评估。采用贝叶斯随机效应模型纳入直接和间接治疗比较的估计值，并对干预措施进行排序。贝叶斯 NMA 的效应估计值以均数差（MD）和 95%可信区间（CrI）表示。

结果

本 NMA 评估了 7 项试验中用于腰骶神经根痛的骶管（C）、椎间（IL）、经椎间孔（TF）和旁正中椎间（PIL）硬膜外注射方法。在短期随访中，中线间（MIL）与 PIL（MD，1.16；95%CrI，0.31-2.06）、MIL 与 TF（MD，1.12；95%CrI，0.51-1.85）、C 与 TF（MD，1.07；95%CrI，0.01-2.18）之间的疼痛缓解存在统计学显著差异，在中期随访中，MIL 与 TF（MD，1.8；95%CrI，0.3-3.48）之间也存在统计学显著差异。在功能改善方面，在短期随访中，MIL 与 PIL（MD，9.9；95%CrI，0.64-19.94）和 MIL 与 TF（MD，1.08；95%CrI，1.08-17.08）之间存在统计学显著差异。此外，在短期和中期随访中，PIL 方法和 TF 方法在疼痛缓解和功能改善方面均排名前 2。