Mahmoud Atef Mohamed, Shawky Mohamed Ahmed, Farghaly Omer Sayed, Botros Joseph Makram, Alsaeid Mohamed Awad, Ragab Safaa Gaber
Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Fayoum University, Faiyum, Egypt.
Pain Pract. 2024 Feb;24(2):341-363. doi: 10.1111/papr.13297. Epub 2023 Sep 12.
Low back pain (LBP) and lumbosacral radiculopathy are frequent disorders that cause nerve root injury, resulting in a variety of symptoms ranging from loss of sensation to loss of motor function depending on the degree of nerve compression.
The goal of this study was to investigate the effectiveness of various epidural injection procedures in adult LBP patients.
Systematic review and network meta-analysis.
Egypt.
PubMed, Scopus, Web of Science, Cochrane Database, and Embase were used to conduct an electronic literature search. We included RCTs, cohorts, case controls, patients 30 years old with a clinical presentation of low back pain, and comprehensive data on the effects of the intervention on patients with lumbosacral radicular pain who got epidural steroid injections via various techniques. Only papers written in English were eligible.
Our analysis showed that parasagittal intralaminar (PIL) was the most effective approach in decreasing VAS (0-10) in the short term (< 6 months) (MD = -1.16 [95% CI -2.04, -0.28]). The next significant approach was transforaminal (TF) (MD = -0.37 [95% CI -1.14, -0.32]) in the long term; TF was the most effective approach (MD = -0.56 [95% CI -1, -0.13]). According to VAS (0-100) in the short term (< 6 months), our analysis showed an insignificant difference among the injection approaches and in the long term; TF was the most effective approach (MD = -24.20 [95% CI -43.80, -4.60]) and the next significant approach was PIL (MD = -23.89 [95% CI -45.78, -1.99]).
The main limitations are the heterogeneity encountered in some of our analyses in addition to studies assessed as high risk of bias in some domains.
TF was the most effective steroid injection approach. In decreasing VAS for short-term PIL and TF were the most significant approaches, but TF was the most effective approach in decreasing VAS for the long term. Also, TF was the most effective approach in decreasing ODI for the long term.
腰痛（LBP）和腰骶神经根病是常见疾病，可导致神经根损伤，根据神经受压程度，会产生从感觉丧失到运动功能丧失等一系列症状。
本研究的目的是调查各种硬膜外注射程序对成年腰痛患者的有效性。
系统评价和网状Meta分析。
埃及。
使用PubMed、Scopus、Web of Science、Cochrane数据库和Embase进行电子文献检索。我们纳入了随机对照试验、队列研究、病例对照研究，年龄≥30岁且有腰痛临床表现的患者，以及关于通过各种技术进行硬膜外类固醇注射对腰骶神经根性疼痛患者干预效果的综合数据。仅纳入英文撰写的论文。
我们的分析表明，矢状旁椎板内（PIL）注射是短期内（<6个月）降低视觉模拟评分（VAS，0 - 10分）最有效的方法（MD = -1.16 [95%CI -2.04, -0.28]）。其次有效的方法是长期经椎间孔（TF）注射（MD = -0.37 [95%CI -1.14, -0.32]）；TF是最有效的方法（MD = -0.56 [95%CI -1, -0.13]）。根据短期内（<6个月）的VAS（0 - 100分），我们的分析表明各注射方法之间无显著差异，而长期来看，TF是最有效的方法（MD = -24.20 [95%CI -43.80, -4.60]），其次有效的方法是PIL（MD = -23.89 [95%CI -45.78, -1.99]）。
主要局限性在于我们的一些分析中存在异质性，以及部分领域的研究被评估为存在高偏倚风险。
TF是最有效的类固醇注射方法。短期内降低VAS，PIL和TF是最显著的方法，但长期来看，TF是降低VAS最有效的方法。此外，长期来看，TF是降低功能障碍指数（ODI）最有效的方法。
