Than Christian A, Valiotis Angelique K, Prottoy Abid R, Alexander Kyle G, Alogakos Marios, Adra Maamoun, Smayra Karen, Curtis Tom J, Kim Grace E, Nakanishi Hayato, Dannawi Zaher
Biomedical Sciences, The University of Queensland, Brisbane, AUS.
Pediatrics, University of Nicosia, Limassol, CYP.
Cureus. 2024 Jul 5;16(7):e63880. doi: 10.7759/cureus.63880. eCollection 2024 Jul.
Corroborative evidence for discectomy in pediatric or adolescent patients remains scarce, with this single-arm meta-analysis investigating discectomy for lumbar disc herniation (LDH) within this population. PubMed, Embase (Elsevier), CiNAHL, Cochrane Library, Scopus, and Web of Science were searched. Eligible studies reported pediatric patients under 21 years of age with a diagnosis of LDH that was treated surgically with discectomy. This review was registered in PROSPERO (ID: CRD42023463358). Twenty-two studies met the eligibility criteria (n=1182). Visual analog scale (VAS) scores for back pain at baseline were 5.34 (95% CI: 4.48, 6.20, I=98.9%). Postoperative VAS back pain scores after 12 months were 0.88 (95% CI: 0.57, 1.19, I=95.6%). VAS scores for leg pain at baseline were 7.03 (95% CI: 6.63, 7.43, I=93.5%). Postoperative VAS leg pain scores after 12 months were 1.02 (95% CI: 0.68, 1.36, I=97.0%). Oswestry disability index (ODI) scores at baseline were 55.46 (95% CI: 43.69, 67.24, I=99.9%). Postoperative ODI scores after 12 months were 7.82 (95% CI: 4.95, 10.69, I=99.4%). VAS back, VAS leg and ODI scores demonstrated a minimum clinically important difference (MCID) at all postoperative points. Perioperative outcomes demonstrated operative time as 85.71 mins (95% CI: 73.96, 97.46, I=99.4%) and hospital length of stay as 3.81 days (95% CI: 3.20, 4.41, I=98.5%). The postoperative reoperation rate at the same level was 0.01 (95% CI: <0.00, 0.02, I=0%). Discectomy appears safe and effective in pediatric and adolescent patients suffering from LDH. The findings here provide groundwork for future randomized control trials against conservative measures to elaborate on optimal management and elucidate long-term outcomes.
关于小儿或青少年患者椎间盘切除术的确凿证据仍然很少，本单臂荟萃分析研究了该人群中腰椎间盘突出症（LDH）的椎间盘切除术。检索了PubMed、Embase（爱思唯尔）、护理及健康领域数据库（CiNAHL）、考克兰图书馆、Scopus和科学网。符合条件的研究报告了21岁以下诊断为LDH并接受椎间盘切除术手术治疗的儿科患者。本综述已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42023463358）注册。22项研究符合纳入标准（n=1182）。基线时背痛的视觉模拟量表（VAS）评分为5.34（95%CI：4.48，6.20，I=98.9%）。12个月后的术后VAS背痛评分为0.88（95%CI：0.57，1.19，I=95.6%）。基线时腿痛的VAS评分为7.03（95%CI：6.63，7.43，I=93.5%）。12个月后的术后VAS腿痛评分为1.02（95%CI：0.68，1.36，I=97.0%）。奥斯维斯特残疾指数（ODI）基线评分为55.46（95%CI：43.69，67.24，I=99.9%）。1个月后的术后ODI评分为7.82（95%CI：4.95，10.69，I=99.4%）。VAS背痛、VAS腿痛和ODI评分在所有术后时间点均显示出最小临床重要差异（MCID）。围手术期结果显示手术时间为85.71分钟（95%CI：73.96，97.46，I=99.4%），住院时间为3.81天（95%CI：3.20，4.41，I=98.5%）。同一水平的术后再次手术率为0.01（95%CI：<0.00，0.02，I=0%）。椎间盘切除术在患有LDH的小儿和青少年患者中似乎是安全有效的。这里的研究结果为未来针对保守治疗措施的随机对照试验奠定了基础，以详细阐述最佳治疗方案并阐明长期预后。
