Hincapié Cesar A, Kroismayr Daniela, Hofstetter Léonie, Kurmann Astrid, Cancelliere Carol, Raja Rampersaud Y, Boyle Eleanor, Tomlinson George A, Jadad Alejandro R, Hartvigsen Jan, Côté Pierre, Cassidy J David
EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland.
Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
Eur Spine J. 2025 Jan;34(1):263-294. doi: 10.1007/s00586-024-08528-8. Epub 2024 Oct 25.
Lumbar disc herniation (LDH) with radiculopathy is associated with greater pain, disability, healthcare use, and costs compared with nonspecific low back pain. Reliable information about its incidence and risk factors were lacking.
(1) What is the incidence of lumbar disc herniation (LDH) with radiculopathy in adults? (2) What are the risk factors for LDH with radiculopathy in adults?
Systematic review. We searched five electronic databases from 1970 to September 2023. Eligible cohort and case-control studies were identified and independently assessed for risk of bias. A qualitative best evidence synthesis of low and moderate risk of bias studies was conducted.
We critically reviewed 87 studies and synthesised data from 59 (68%) studies; 12 were of low and 47 of moderate risk of bias. The lower and upper bound limits of the 95% CIs of annual incidence estimates ranged from 0.3 to 2.7 per 1000 persons for surgical case definitions, from 0.04 to 1.5 per 1,000 persons for hospital-based case definitions, and from 0.1 to 298.3 per 1,000 persons for clinical case definitions. Factors associated with the development of LDH with radiculopathy included middle-age (30-50 years), smoking, higher BMI, presence of cardiovascular risk factors (in women), and greater cumulative occupational lumbar load by forward bending postures and manual materials handling, with effect sizes ranging from ranging from 1.1 (1.0-1.3) to 3.7 (2.3-6.0).
Incidence of LDH varies in different populations and according to case definition. Risk factors include individual, behavioural, and work-related variables. Our findings support the need to develop standardised case definitions that validly classify the clinical spectrum of LDH and for future low risk of bias studies examining causal relationships for LDH with radiculopathy in adults.
与非特异性腰痛相比，伴有神经根病的腰椎间盘突出症（LDH）会带来更严重的疼痛、功能障碍、医疗资源利用和费用。缺乏关于其发病率和危险因素的可靠信息。
（1）成人伴有神经根病的腰椎间盘突出症（LDH）的发病率是多少？（2）成人伴有神经根病的LDH的危险因素有哪些？
系统评价。我们检索了1970年至2023年9月的五个电子数据库。识别符合条件的队列研究和病例对照研究，并独立评估偏倚风险。对低偏倚风险和中偏倚风险的研究进行了定性的最佳证据综合分析。
我们严格审查了87项研究，并综合了59项（68%）研究的数据；12项为低偏倚风险，47项为中偏倚风险。手术病例定义的年发病率估计值的95%置信区间的下限和上限范围为每1000人0.3至2.7，基于医院病例定义的范围为每1000人0.04至1.5，临床病例定义的范围为每1000人0.1至298.3。与伴有神经根病的LDH发生相关的因素包括中年（30 - 50岁）、吸烟、较高的体重指数、心血管危险因素（女性）的存在，以及前屈姿势和手工搬运材料导致的累积职业性腰部负荷增加，效应大小范围为1.1（1.0 - 1.3）至3.7（2.3 - 6.0）。
LDH的发病率在不同人群中以及根据病例定义而有所不同。危险因素包括个体、行为和与工作相关的变量。我们的研究结果支持需要制定能够有效分类LDH临床谱的标准化病例定义，并支持未来进行低偏倚风险研究，以检验成人伴有神经根病的LDH的因果关系。
