Song Ke, Liang Jie, Zhang Meiling, Cai Songlin, Wang Yanfei, Wu Weifei
The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443000, China.
Yichang Central People's Hospital, Yichang, 443000, China.
BMC Surg. 2025 Jul 3;25(1):259. doi: 10.1186/s12893-025-02992-9.
Lumbar disc herniation (LDH) is a prevalent spinal disorder that imposes substantial health burdens in the form of chronic pain and mobility limitations, particularly in working-age populations. Due to advancements in technology and materials, the treatments for LDH are constantly being updated.
The purpose of this systematic review and network meta-analysis (NMA) was to compare the outcomes of different LDH treatments.
A NMA of randomized controlled trials (RCTs) comparing various treatments for LDH.
This review was conducted in accordance with to the PRISMA-P guidelines. The PubMed, Embase, Medline, and Cochrane Library electronic databases were systematically searched from 2007 to March 2024 to identify RCTs comparing various treatments for LDH. The outcomes of interest included changes in the pain score, disability score and recurrence rate at the one-year follow-up. The risk of bias among the included studies was assessed using the Cochrane method. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was tailored for network meta-analysis and used to evaluate the overall certainty of the evidence regarding each outcome. This study employed a frequentist approach to conduct the NMA, and all procedures were carried out using the network package in Stata 14.2. The PROSPERO number was CRD42024578677.
Twenty-seven RCTs involving 4633 participants and seven treatment strategies were included. Compared with conservative treatments, all surgical interventions demonstrated better efficacy in pain relief and disability recovery. Among the surgical options, endoscopic discectomy with internal fixation (EDF), percutaneous endoscopic discectomy (PED), microdiscectomy (MD) and open discectomy (OD) were found to be significantly superior to conservative treatments, with EDF showing the best performance. Surface under the cumulative ranking curve (SUCRA) plots displayed the same trend as the NMA results. No significant differences were observed in terms of recurrence rates. However, the SUCRA plots indicated that EDF ranked best in terms of recurrence rates. The GRADE assessment revealed that the quality of most of the evidence was low or very low.
The implantation of internal fixation devices was shown to have no impact on quality of life. EDF appears highly effective, especially for pain relief, but other less invasive options, such as PED, have similarly good outcomes in many respects.
腰椎间盘突出症（LDH）是一种常见的脊柱疾病，以慢性疼痛和活动受限的形式给健康带来沉重负担，尤其是在工作年龄人群中。由于技术和材料的进步，LDH的治疗方法不断更新。
本系统评价和网状Meta分析（NMA）的目的是比较不同LDH治疗方法的疗效。
一项比较LDH各种治疗方法的随机对照试验（RCT）的NMA。
本评价按照PRISMA-P指南进行。对2007年至2024年3月的PubMed、Embase、Medline和Cochrane图书馆电子数据库进行系统检索，以识别比较LDH各种治疗方法的RCT。感兴趣的结局包括一年随访时疼痛评分、残疾评分和复发率的变化。采用Cochrane方法评估纳入研究的偏倚风险。推荐分级、评估、制定和评价（GRADE）方法针对网状Meta分析进行了调整，并用于评估每个结局证据的总体确定性。本研究采用频率学派方法进行NMA，所有程序均使用Stata 14.2中的netmeta软件包进行。PROSPERO注册号为CRD42024578677。
纳入了27项涉及4633名参与者和7种治疗策略的RCT。与保守治疗相比，所有手术干预在缓解疼痛和恢复功能方面均显示出更好的疗效。在手术选择中，内镜下椎间盘切除术联合内固定（EDF）、经皮内镜下椎间盘切除术（PED）、显微椎间盘切除术（MD）和开放性椎间盘切除术（OD）被发现明显优于保守治疗，其中EDF表现最佳。累积排序曲线下面积（SUCRA）图显示出与NMA结果相同的趋势。在复发率方面未观察到显著差异。然而，SUCRA图表明EDF在复发率方面排名最佳。GRADE评估显示，大多数证据的质量为低或极低。
内固定装置的植入对生活质量没有影响。EDF似乎非常有效，尤其是在缓解疼痛方面，但其他侵入性较小的选择，如PED，在许多方面也有类似的良好效果。
