In:
Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 98, No. 7 ( 2019-02), p. e14410-
Abstract:
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 〈 .001) and back pain (MD −7, P 〈 .001). LD + AC was more effective than LD in reducing risk of reherniation (odds ratio 0.38, P 〈 .001) and reoperation (odds ratio 0.33, P 〈 .001). There was indirect evidence that LD + AC was more effective than CC in reducing leg pain (MD −25, P = .003), back pain (MD −20, P = .02), and disability (MD −13, P = .02) although the treatment effect was smaller in randomized trials. Conclusions: Results of a network meta-analysis show LD is more effective than CC in alleviating symptoms of lumbar disc herniation refractory to initial conservative management. Further, LD + AC lowers risk of reherniation and reoperation versus LD and may improve patient symptoms more than CC.
Type of Medium:
Online Resource
ISSN:
0025-7974
,
1536-5964
DOI:
10.1097/MD.0000000000014410
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
detail.hit.zdb_id:
2049818-4
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