Cargando…
Intervertebral disc therapies for non-specific chronic low back pain: a systematic review and meta-analysis
OBJECTIVES: We aim to evaluate the benefits and harms of intervertebral disc therapies (IDTs) in people with non-specific chronic low back pain (NScLBP). METHODS: We conducted a systematic review and meta-analysis of randomized trials of IDTs versus placebo interventions, active comparators or usual...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287365/ https://www.ncbi.nlm.nih.gov/pubmed/34349845 http://dx.doi.org/10.1177/1759720X211028001 |
_version_ | 1783723902797611008 |
---|---|
author | Daste, Camille Laclau, Stéphanie Boisson, Margaux Segretin, François Feydy, Antoine Lefèvre-Colau, Marie-Martine Rannou, François Nguyen, Christelle |
author_facet | Daste, Camille Laclau, Stéphanie Boisson, Margaux Segretin, François Feydy, Antoine Lefèvre-Colau, Marie-Martine Rannou, François Nguyen, Christelle |
author_sort | Daste, Camille |
collection | PubMed |
description | OBJECTIVES: We aim to evaluate the benefits and harms of intervertebral disc therapies (IDTs) in people with non-specific chronic low back pain (NScLBP). METHODS: We conducted a systematic review and meta-analysis of randomized trials of IDTs versus placebo interventions, active comparators or usual care. EMBASE, MEDLINE, CENTRAL and CINHAL databases and conference abstracts were searched from inception to June 2020. Two independent investigators extracted data. The primary outcome was LBP intensity at short term (1 week–3 months), intermediate term (3–6 months) and long term (after 6 months). RESULTS: Of 18 eligible trials (among 1396 citations), five assessed glucocorticoids (GCs) IDTs and were included in a quantitative synthesis; 13 assessed other products including etanercept (n = 2), tocilizumab (n = 1), methylene blue (n = 2), ozone (n = 2), chymopapaine (n = 1), glycerol (n = 1), stem cells (n = 1), platelet-rich plasma (n = 1) and recombinant human growth and differentiation factor-5 (n = 2), and were included in a narrative synthesis. Standardized mean differences (95% CI) for GC IDTs for LBP intensity and activity limitations were −1.33 (−2.34; −0.32) and −0.76 (−1.85; 0.34) at short term, −2.22 (−5.34; 0.90) and −1.60 (−3.51; 0.32) at intermediate term and −1.11 (−2.91; 0.70) and −0.63 (−1.68; 0.42) at long term, respectively. Odds ratios (95% CI) for serious and minor adverse events with GC IDTs were 1.09 (0.25; 4.65) and 0.97 (0.49; 1.91). CONCLUSION: GC IDTs are associated with a reduction in LBP intensity at short term in people with NScLBP. Positive effects are not sustained. IDTs have no effect on activity limitations. Our conclusions are limited by high heterogeneity and a limited methodological quality across studies. REGISTRATION: PROSPERO: CRD42019106336. |
format | Online Article Text |
id | pubmed-8287365 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-82873652021-08-03 Intervertebral disc therapies for non-specific chronic low back pain: a systematic review and meta-analysis Daste, Camille Laclau, Stéphanie Boisson, Margaux Segretin, François Feydy, Antoine Lefèvre-Colau, Marie-Martine Rannou, François Nguyen, Christelle Ther Adv Musculoskelet Dis Systematic Review OBJECTIVES: We aim to evaluate the benefits and harms of intervertebral disc therapies (IDTs) in people with non-specific chronic low back pain (NScLBP). METHODS: We conducted a systematic review and meta-analysis of randomized trials of IDTs versus placebo interventions, active comparators or usual care. EMBASE, MEDLINE, CENTRAL and CINHAL databases and conference abstracts were searched from inception to June 2020. Two independent investigators extracted data. The primary outcome was LBP intensity at short term (1 week–3 months), intermediate term (3–6 months) and long term (after 6 months). RESULTS: Of 18 eligible trials (among 1396 citations), five assessed glucocorticoids (GCs) IDTs and were included in a quantitative synthesis; 13 assessed other products including etanercept (n = 2), tocilizumab (n = 1), methylene blue (n = 2), ozone (n = 2), chymopapaine (n = 1), glycerol (n = 1), stem cells (n = 1), platelet-rich plasma (n = 1) and recombinant human growth and differentiation factor-5 (n = 2), and were included in a narrative synthesis. Standardized mean differences (95% CI) for GC IDTs for LBP intensity and activity limitations were −1.33 (−2.34; −0.32) and −0.76 (−1.85; 0.34) at short term, −2.22 (−5.34; 0.90) and −1.60 (−3.51; 0.32) at intermediate term and −1.11 (−2.91; 0.70) and −0.63 (−1.68; 0.42) at long term, respectively. Odds ratios (95% CI) for serious and minor adverse events with GC IDTs were 1.09 (0.25; 4.65) and 0.97 (0.49; 1.91). CONCLUSION: GC IDTs are associated with a reduction in LBP intensity at short term in people with NScLBP. Positive effects are not sustained. IDTs have no effect on activity limitations. Our conclusions are limited by high heterogeneity and a limited methodological quality across studies. REGISTRATION: PROSPERO: CRD42019106336. SAGE Publications 2021-07-16 /pmc/articles/PMC8287365/ /pubmed/34349845 http://dx.doi.org/10.1177/1759720X211028001 Text en © The Author(s), 2021 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Systematic Review Daste, Camille Laclau, Stéphanie Boisson, Margaux Segretin, François Feydy, Antoine Lefèvre-Colau, Marie-Martine Rannou, François Nguyen, Christelle Intervertebral disc therapies for non-specific chronic low back pain: a systematic review and meta-analysis |
title | Intervertebral disc therapies for non-specific chronic low back pain:
a systematic review and meta-analysis |
title_full | Intervertebral disc therapies for non-specific chronic low back pain:
a systematic review and meta-analysis |
title_fullStr | Intervertebral disc therapies for non-specific chronic low back pain:
a systematic review and meta-analysis |
title_full_unstemmed | Intervertebral disc therapies for non-specific chronic low back pain:
a systematic review and meta-analysis |
title_short | Intervertebral disc therapies for non-specific chronic low back pain:
a systematic review and meta-analysis |
title_sort | intervertebral disc therapies for non-specific chronic low back pain:
a systematic review and meta-analysis |
topic | Systematic Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287365/ https://www.ncbi.nlm.nih.gov/pubmed/34349845 http://dx.doi.org/10.1177/1759720X211028001 |
work_keys_str_mv | AT dastecamille intervertebraldisctherapiesfornonspecificchroniclowbackpainasystematicreviewandmetaanalysis AT laclaustephanie intervertebraldisctherapiesfornonspecificchroniclowbackpainasystematicreviewandmetaanalysis AT boissonmargaux intervertebraldisctherapiesfornonspecificchroniclowbackpainasystematicreviewandmetaanalysis AT segretinfrancois intervertebraldisctherapiesfornonspecificchroniclowbackpainasystematicreviewandmetaanalysis AT feydyantoine intervertebraldisctherapiesfornonspecificchroniclowbackpainasystematicreviewandmetaanalysis AT lefevrecolaumariemartine intervertebraldisctherapiesfornonspecificchroniclowbackpainasystematicreviewandmetaanalysis AT rannoufrancois intervertebraldisctherapiesfornonspecificchroniclowbackpainasystematicreviewandmetaanalysis AT nguyenchristelle intervertebraldisctherapiesfornonspecificchroniclowbackpainasystematicreviewandmetaanalysis |