Riegger Martin, Le Huyen, van Kuijk Sander M J, Guyenes Gabor, Candrian Christian, Cianfoni Alessandro, Hirsch Joshua A, Koetsier Eva
Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, the Netherlands.
Pain Physician. 2023 Sep;26(5):E449-E465.
The benefit of intradiscal glucocorticoid injection (IGI) for discogenic low back pain (LBP) remains controversial.
The objective of this study was to systematically assess and meta-analyze the efficacy of IGI compared with these control groups.
Systematic review and meta-analysis.
A comprehensive literature search was performed screening PubMed and Embase through May 2022. Only randomized controlled trials (RCTs) comparing IGI to control groups in adult patients with discogenic lumbar back pain were included. A random effects model was used to pool mean differences of pain intensity (visual analaog scale [VAS] 0-100), and physical function assessed with the Oswestry Disability Index (ODI). Subgroup analyses were stratified by Modic magnetic resonance imaging findings.
Seven studies met inclusion criteria with a total of 626 patients. The short-term (< 3 months) follow-up showed a significant pooled mean difference in both pain intensity (-20.1; 95% CI, -25.5 to -14.7) and physical function (-9.9; 95% CI, -16.1 to -3.6). In the intermediate -term follow-up (3 to < 6 months), only physical function remained significantly better in the glucocorticoid group (-13.1; 95% CI, -22.3 to -3.9). There was no clinically meaningful or significant difference in pain scores and physical function at the long-term (>= 6 months) follow-up. A subgroup analysis did not demonstrate an effect of Modic (type I) changes on the efficacy of IGI.
A limited number of studies was available and consequently publication bias could not be evaluated using a funnel plot. Statistical heterogeneity was detected among the included studies.
We conclude that IGI reduces discogenic LBP intensity and improves physical function effectively at short-term follow-up, and continues to improve physical function at intermediate-term. However, 6 months posttreatment, outcomes are similar in comparison to the control groups. The type of Modic change does not appear to be related with the response to IGI.
Low back pain, lumbar back pain, intradiscal glucocorticoid injection, modic changes, meta-analysis.
椎间盘内注射糖皮质激素（IGI）治疗椎间盘源性下腰痛（LBP）的益处仍存在争议。
本研究的目的是系统评估并荟萃分析IGI与这些对照组相比的疗效。
系统评价和荟萃分析。
通过检索截至2022年5月的PubMed和Embase进行全面的文献检索。仅纳入比较IGI与成年椎间盘源性腰痛患者对照组的随机对照试验（RCT）。采用随机效应模型汇总疼痛强度（视觉模拟量表[VAS]0-100）的平均差异，以及用Oswestry功能障碍指数（ODI）评估的身体功能。亚组分析按Modic磁共振成像结果分层。
七项研究符合纳入标准，共626例患者。短期（<3个月）随访显示，疼痛强度（-20.1；95%CI，-25.5至-14.7）和身体功能（-9.9；95%CI，-16.1至-3.6）的汇总平均差异均有统计学意义。在中期随访（3至<6个月）中，只有糖皮质激素组的身体功能仍显著更好（-13.1；95%CI，-22.3至-3.9）。在长期（≥6个月）随访中，疼痛评分和身体功能无临床意义或显著差异。亚组分析未显示Modic（I型）改变对IGI疗效有影响。
可用研究数量有限，因此无法使用漏斗图评估发表偏倚。纳入研究之间检测到统计学异质性。
我们得出结论，IGI在短期随访中可有效降低椎间盘源性LBP强度并改善身体功能，在中期仍能持续改善身体功能。然而，治疗后6个月，与对照组相比结果相似。Modic改变的类型似乎与对IGI的反应无关。
下腰痛，腰椎痛，椎间盘内注射糖皮质激素，Modic改变，荟萃分析
