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Comparison of treatments for lumbar disc herniation: Systematic review with network meta-analysis.

ABSTRACT: STUDY DESIGN:Systematic review with network meta-analysis. OBJECTIVE:To compare patient outcomes of lumbar discectomy with bone-anchored annular closure (LD?+?AC), lumbar discectomy (LD), and continuing conservative care (CC) for treatment of lumbar disc herniation refractory to initial conservative management. SUMMARY OF BACKGROUND DATA:Several treatment options are available to patients with refractory symptoms of lumbar disc herniation, but their comparative efficacy is unclear. METHODS:A systematic review was performed to compare efficacy of LD?+?AC, LD, and CC for treatment of lumbar disc herniation. Outcomes included leg pain, back pain, disability (each reported on a 0-100 scale), reherniation, and reoperation. Data were analyzed using random effects network meta-analysis. RESULTS:This review included 14 comparative studies (8 randomized) involving 3947 patients-11 studies of LD versus CC (3232 patients), 3 studies of LD?+?AC versus LD (715 patients), and no studies of LD?+?AC versus CC. LD was more effective than CC in reducing leg pain (mean difference [MD] -10, P?

SUBMITTER: Arts MP

PROVIDER: S-EPMC6408089 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Comparison of treatments for lumbar disc herniation: Systematic review with network meta-analysis.

Arts Mark P MP Kuršumović Adisa A Miller Larry E LE Wolfs Jasper F C JFC Perrin Jason M JM Van de Kelft Erik E Heidecke Volkmar V

Medicine 20190201 7

<h4>Study design</h4>Systematic review with network meta-analysis.<h4>Objective</h4>To compare patient outcomes of lumbar discectomy with bone-anchored annular closure (LD + AC), lumbar discectomy (LD), and continuing conservative care (CC) for treatment of lumbar disc herniation refractory to initial conservative management.<h4>Summary of background data</h4>Several treatment options are available to patients with refractory symptoms of lumbar disc herniation, but their comparative efficacy is ...[more]

PMID: 30762743

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Project description:Objective:Lumbar disc herniation (LDH) is based on the degenerative changes of the intervertebral disc. Many drugs are used to treat and prevent LDH, including Western medicine and Chinese medicine. Duhuo Jisheng Decoction (DHJSD) is one of the most classic Chinese medicine prescriptions. The purpose of our meta-analysis is to evaluate the efficacy and safety of modified DHJSD in the treatment of LDH. Methods:We searched multiple databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI) databases, Wanfang Database, and Chinese Scientific Journal Database (VIP) to identify studies that met the inclusion criteria. This meta-analysis was registered at INPLASY with reference number ID: INPLASY202060053. Results:Fourteen randomized controlled trials (RCTs) were identified, including 1560 patients. This meta-analysis showed that the total effective rate and cure rate of modified DHJSD are higher than those of diclofenac sodium enteric-coated tablets (total effective rate: RR?=?1.18, 95% CI: 1.12 to 1.25, P < 0.0001, I 2?=?0%; cure rate: RR?=?1.60, 95% CI: 1.30 to 1.97, P < 0.00001, I 2?=?2%), diclofenac sodium enteric-coated tablets plus ibuprofen and indomethacin (total effective rate: RR?=?1.23, 95% CI: 1.11 to 1.37, P=0.0001, I 2?=?0%; cure rate: RR?=?1.58, 95% CI: 1.22 to 2.04, P=0.0005, I 2?=?0%), and diclofenac sodium sustained-release capsule (total effective rate: RR?=?1.49, 95% CI: 1.27 to 1.74, P < 0.00001, I 2?=?0%; cure rate: RR?=?10.07, 95% CI: 3.29 to 30.88, P < 0.00001, I 2?=?5%). Modified DHJSD was also better than Western medicine (MD?=?-1.56, 95% CI: -2.42 to -0.70, P=0.0004, I 2?=?74%) in terms of visual analogue scale (VAS) scores. Three RCTs showed no adverse events in the modified DHJSD group, but adverse events existed in the Western medicine group. Conclusion:This meta-analysis showed that modified DHJSD had a more favorable effect on the treatment of LDH than Western medicine, and there were no obvious adverse events. More high-quality RCTs are needed to complement existing conclusions.

Dataset Information

Comparison of treatments for lumbar disc herniation: Systematic review with network meta-analysis.

Publications

Comparison of treatments for lumbar disc herniation: Systematic review with network meta-analysis.

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