Jin Haiyue, Lopez Alexander M, Romero Flor Garza, Hoang Ryan, Ramesh Ashish, Bow Hansen C
The University of California, Irvine, School of Medicine, Irvine, CA, USA.
Department of Neurosurgery, University of California, Irvine, Orange, CA, USA.
Neurospine. 2025 Jun;22(2):389-402. doi: 10.14245/ns.2550398.199. Epub 2025 Jun 30.
Various treatments have been developed for treating herniated lumbar discs (HLD), which have been examined by professional associations when composing clinical guidelines that provide structured approaches to treating HLD. This paper aims to gather recent guidelines and summarize their conclusions on nonsurgical and surgical treatment options. PubMed, Web of Science, Scopus, Guidelines International Network, Turning Research into Practice databases, and websites of medical societies were searched for clinical guidelines of HLD. Full-text guidelines published by a professional association in English relevant to HLD were included. Comparisons among guidelines were made based on the treatments evaluated, and recommendation grades were recorded when provided by the guidelines. A total of 12 guidelines were included, with 4 by non-United States (US) or international associations, 3 by US pain societies, 2 by surgical societies, 2 by government agencies, and 1 by a multidisciplinary medical society. Treatments assessed included surgical, invasive nonsurgical, and noninvasive nonsurgical interventions. Three guidelines did not include surgical treatments, and 2 guidelines did not include nonsurgical therapies. Recommendation criteria varied among guidelines due to differences in the intended audience. HLD can be treated with various modalities with specific therapies offering better pain relief. Despite inconsistency in the recommendation grades of most treatments, established surgical techniques and epidural injections were reported with higher confidence in recommendation estimates, while inadequate supporting evidence was shown for noninvasive therapies except cognitive behavioral therapy. Future studies could incorporate and comment on some of the newer methods of treating HLD.
针对腰椎间盘突出症(HLD)已开发出多种治疗方法,专业协会在制定提供HLD结构化治疗方法的临床指南时对这些方法进行了审查。本文旨在收集近期指南并总结其关于非手术和手术治疗选择的结论。在PubMed、科学网、Scopus、国际指南网络、将研究转化为实践数据库以及医学协会网站上搜索HLD的临床指南。纳入由专业协会以英文发表的与HLD相关的全文指南。根据所评估的治疗方法对指南进行比较,并记录指南提供的推荐等级。共纳入12项指南,其中4项由非美国或国际协会制定,3项由美国疼痛协会制定,2项由外科协会制定,2项由政府机构制定,1项由多学科医学协会制定。评估的治疗方法包括手术、侵入性非手术和非侵入性非手术干预。3项指南未包括手术治疗,2项指南未包括非手术治疗。由于目标受众不同,指南中的推荐标准也有所不同。HLD可用多种方式治疗,特定疗法能更好地缓解疼痛。尽管大多数治疗方法的推荐等级不一致,但已确立的手术技术和硬膜外注射在推荐估计中的可信度较高,而除认知行为疗法外的非侵入性疗法的支持证据不足。未来的研究可以纳入并评论一些治疗HLD的新方法。
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