Lee Jong Joo, Chang Min Cheol, Shin Dong Ah, Park Jin Hoon, Choi Miyoung, Park Hyung-Youl, Kim In Soo, Lee Jung-Kil, Chough Chung-Kee, Yoon Seung Hwan, Choi Seong-Soo, Choi Sung-Woo
Department of Neurosurgery, Sungkyunkwan University Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea.
Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Korea.
Neurospine. 2025 Jun;22(2):366-383. doi: 10.14245/ns.2550094.047. Epub 2025 Jun 30.
In this study, we aimed to develop evidence-based clinical practice guidelines (CPGs) for the treatment of lumbar disc herniation (LDH) with radiculopathy, tailored to South Korean clinical settings.
The guideline development process used followed the evidence-based medicine principles. Literature searches were conducted across databases, including MEDLINE (PubMed), Cochrane, Embase, and KoreaMed, using predefined search strategies. Titles and abstracts were reviewed to identify the best research evidence. Data extraction and quality assessment were performed using the Cochrane risk of bias tool and the GRADE method. Quantitative meta-analyses or qualitative synthesis were conducted based on data heterogeneity. Recommendations were assigned strength grades (A, B, C, D, I) reflecting evidence reliability.
In these guidelines, comprehensive recommendations for managing LDH with radiculopathy in clinical settings were provided. International evidence and multidisciplinary expert opinions were integrated. Four key clinical questions were identified and divided into sections: surgical treatment, interventional treatment, and physical treatment/exercise. The recommendations for these questions are summarized in this article.
The aim of establishing these CPGs was to enhance treatment outcomes, reduce healthcare costs, and promote public health. By recognizing limitations in domestic data and the dynamic healthcare circumstances, the need for continuous revision was emphasized in these guidelines. Nonetheless, in future updates, the guidelines will be refined to improve their quality and applicability in clinical practice.
在本研究中,我们旨在制定基于证据的临床实践指南(CPG),用于治疗伴有神经根病的腰椎间盘突出症(LDH),该指南是针对韩国临床环境量身定制的。
指南制定过程遵循循证医学原则。使用预定义的检索策略,在包括MEDLINE(PubMed)、Cochrane、Embase和KoreaMed在内的多个数据库中进行文献检索。对标题和摘要进行审查以确定最佳研究证据。使用Cochrane偏倚风险工具和GRADE方法进行数据提取和质量评估。根据数据异质性进行定量荟萃分析或定性综合。根据证据可靠性为推荐意见分配强度等级(A、B、C、D、I)。
在这些指南中,提供了在临床环境中管理伴有神经根病的LDH的全面建议。整合了国际证据和多学科专家意见。确定了四个关键临床问题并分为几个部分:手术治疗、介入治疗和物理治疗/运动。本文总结了针对这些问题的建议。
制定这些CPG的目的是提高治疗效果、降低医疗成本并促进公众健康。通过认识到国内数据的局限性和动态的医疗环境,这些指南强调了持续修订的必要性。尽管如此,在未来的更新中,这些指南将得到完善,以提高其质量和在临床实践中的适用性。