Surgical versus non-surgical treatment of chronic low back pain: a meta-analysis of randomised trials
Surgical versus non-surgical treatment of chronic low back pain: a meta-analysis of randomised trials
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DOI：
10.1007/s00264-006-0269-6
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发表时间：
2008-02-01
影响因子：
2.7
通讯作者：
Gabbar, O.
中科院分区：
文献类型：
--
作者：
Ibrahim, T.;Tleyjeh, I. M.;Gabbar, O.
我们进行了一项随机对照试验的荟萃分析，以调查手术融合治疗慢性下腰痛与非手术干预的有效性。检索了1966-2005年间的几个电子数据库(MEDLINE、EMBASE、CINAHL和科学引文索引)。荟萃分析比较是基于接受手术和非手术治疗的患者从基线到特定随访的OSwestry残疾指数(ODI)变化的平均差异。在确定的58篇文章中，3篇研究符合初步分析条件，1篇研究符合敏感性分析，总共有634名患者。手术组与非手术组ODI的合并平均差异更倾向于手术(ODI的平均差异：4.13，95%CI：-0.82~9.08，p=0.10，I-2=44.4%)。手术治疗与16%的早期并发症合并率相关(95%可信区间：12-20，I-2=0)。与非手术治疗相比，手术融合治疗慢性下腰痛的ODI有轻微的改善。ODI的这种差异在统计学上并不显著，临床上的重要性也很小。手术被发现与并发症的显著风险有关。因此，目前的累积证据不支持常规手术融合治疗慢性下腰痛。
We performed a meta-analysis of randomised controlled trials to investigate the effectiveness of surgical fusion for the treatment of chronic low back pain compared to non-surgical intervention. Several electronic databases (MEDLINE, EMBASE, CINAHL and Science Citation Index) were searched from 1966 to 2005. The meta-analysis comparison was based on the mean difference in Oswestry Disability Index (ODI) change from baseline to the specified follow-up of patients undergoing surgical versus non-surgical treatment. Of the 58 articles identified, three studies were eligible for primary analysis and one study for sensitivity analysis, with a total of 634 patients. The pooled mean difference in ODI between the surgical and non-surgical groups was in favour of surgery (mean difference of ODI: 4.13, 95%CI: -0.82 to 9.08, p = 0.10, I-2 = 44.4%). Surgical treatment was associated with a 16% pooled rate of early complication (95%CI: 12-20, I-2 = 0%). Surgical fusion for chronic low back pain favoured a marginal improvement in the ODI compared to non-surgical intervention. This difference in ODI was not statistically significant and is of minimal clinical importance. Surgery was found to be associated with a significant risk of complications. Therefore, the cumulative evidence at the present time does not support routine surgical fusion for the treatment of chronic low back pain.