scholarly journals Systematic Review of the Effectiveness of Thermal Annular Procedures in Treating Discogenic Low Back Pain

2009 ◽  
Vol 1;12 (1;1) ◽  
pp. 207-232 ◽  
Author(s):  
Standiford Helm II
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Outcome Measures ◽  
Observational Studies ◽  
Low Back ◽  
Level Of Evidence ◽  
Level Ii ◽  
Discogenic Low Back Pain ◽  
One Year

Background: Chronic discogenic low back pain is a common problem with significant personal and societal costs. Thermal annular procedures (TAPs) have been developed in an effort to provide a minimally invasive treatment for this disorder. Multiple techniques utilized are intradiscal electrothermal therapy (IDET), radiofrequency annuloplasty, and intradiscal biacuplasty (IDB). However, these treatments continue to be controversial, coupled with a paucity of evidence. Study Design: A systematic review of the literature evaluating the efficacy or effectiveness of TAPs. Objective: To determine the effectiveness of TAPs in reducing low back pain in patients with intradiscal disorders. Methods: A comprehensive evaluation of the literature relating to TAPs was performed. The literature was evaluated according to Cochrane Review criteria for randomized controlled trials (RCTs) and according to the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, and return to work. Data sources included relevant literature of the English language identified through searches of PubMed, EMBASE, the Cochrane Library, and the Database of Reviews of Effectiveness (DARE). Outcome Measures: Short-term effectiveness was defined as one-year or less and long-term effectiveness was defined as greater than one-year. Results: Systematic review of IDET identified 2 RCTs and 16 observational studies with an indicated evidence of Level II-2. Systematic review of radiofrequency annuloplasty identified no RCTs but 2 observational studies with an uncertain evidence of Level II-3. Systematic review of IDB identified one pilot study. The level of evidence is lacking with Level III. Limitations: The limitations of this review include paucity of the literature and lack of evidence with internal validity and generalizability. Conclusion: IDET offers functionally significant relief in approximately one-half of appropriately chosen chronic discogenic low back pain patients. There is minimal evidence supporting the use of radiofrequency annuloplasty and IDB. Key words: Chronic low back pain, degenerative disc disease, internal disc disruption, intervertebral disc, thermal annular procedures, intradiscal electrothermal therapy, radiofrequency ablation, intradiscal biacuplasty, radiofrequency annuloplasty

scholarly journals A Systematic Review of Mechanical Lumbar Disc Decompression with Nucleoplasty

2009 ◽  
Vol 3;12 (3;5) ◽  
pp. 561-572
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Low Back ◽  
Disc Prolapse ◽  
Level Of Evidence ◽  
Level Ii ◽  
Alternative Techniques ◽  
One Year

Background: Lumbar disc prolapse, protrusion, or extrusion account for less than 5% of all low back problems, but are the most common causes of nerve root pain and surgical interventions. The primary rationale for any form of surgery for disc prolapse is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of treatment continues to be either open or microdiscectomy, but several alternative techniques including nucleoplasty, automated percutaneous discectomy, and laser discectomy have been described. There is a paucity of evidence for all decompression techniques, specifically alternative techniques including nucleoplasty. Study Design: A systematic review of the literature. Objective: To determine the effectiveness of mechanical lumbar disc decompression with nucleoplasty. Methods: A comprehensive evaluation of the literature relating to mechanical lumbar disc decompression with nucleoplasty was performed. The literature was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs), and Agency for Healthcare Research and Quality (AHRQ) criteria was utilized for observational studies. The level of evidence was classified as Level I, II, or III with 3 subcategories in Level II based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). A literature search was conducted using only English language literature through PubMed, EMBASE, the Cochrane library, systematic reviews, and cross-references from reviews and systematic reviews. Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, opioid intake, and return to work. Short-term effectiveness was defined as one year or less, whereas, long-term effectiveness was defined as greater than one year. Results: Based on USPSTF criteria the level of evidence for nucleoplasty is Level II-3 in managing predominantly lower extremity pain due to contained disc herniation. Limitations: Paucity of literature, both observational and randomized. Conclusion: This systematic review illustrates Level II-3 evidence for mechanical lumbar percutaneous disc decompression with nucleoplasty in treatment of leg pain. However, there is no evidence available in managing axial low back pain. Key words: Intervertebral disc disease, chronic low back pain, disc herniation, disc protrusion, radiculitis, contained disc herniation, mechanical disc decompression, nucleoplasty, coblation technology, nucleotomy

scholarly journals An Update of the Systematic Assessment of Mechanical Lumbar Disc Decompression with Nucleoplasty

2013 ◽  
Vol 2s;16 (2s;4) ◽  
pp. SE25-SE54 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Disc Herniation ◽  
Observational Studies ◽  
Lumbar Disc ◽  
Radicular Pain ◽  
Low Back ◽  
Level Of Evidence ◽  
Alternative Techniques ◽  
One Year

Background: Lumbar disc prolapse, protrusion, and extrusion account for less than 5% of all low back problems, but are the most common causes of nerve root pain and surgical interventions. The primary rationale for any form of surgery for disc prolapse is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of treatment continues to be either open or microdiscectomy, although several alternative techniques are also utilized, including nucleoplasty, automated percutaneous discectomy and laser discectomy. There is a paucity of evidence for all decompression techniques, specifically alternative techniques including nucleoplasty. Study Design: A systematic review of the literature of mechanical lumbar disc decompression with nucleoplasty. Objective: To determine the effectiveness and update the effectiveness of mechanical lumbar disc decompression with nucleoplasty. Methods: The available literature on mechanical lumbar disc decompression with nucleoplasty was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: Pain relief and functional improvement were the primary outcome measures. Other outcome measures were improvement of psychological status, reduction in opioid intake, and return to work. Short-term effectiveness was defined as one year or less, whereas long-term effectiveness was defined as greater than one year. Results: For this systematic review, 37 studies were considered for inclusion. Of these, there was one randomized trial and 14 observational studies meeting inclusion criteria for methodological quality assessment. Based on USPSTF criteria, the level of evidence for nucleoplasty is limited to fair in managing radicular pain due to contained disc herniation. Limitations: A paucity of literature with randomized trials. Conclusion: This systematic review illustrates limited to fair evidence for nucleoplasty in managing radicular pain due to contained disc herniation. Key words: Intervertebral disc disease, chronic low back pain, disc herniation, disc protrusion, radiculitis, contained disc herniation, mechanical disc decompression, nucleoplasty, Coblation technology, nucleotomy

scholarly journals Systematic Review of Lumbar Discography as a Diagnostic Test for Chronic Low Back Pain

2009 ◽  
Vol 3;12 (3;5) ◽  
pp. 541-599
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Intervertebral Disc ◽  
Diagnostic Accuracy ◽  
Chronic Low Back Pain ◽  
Low Back ◽  
Level Of Evidence ◽  
Methodologic Quality ◽  
Level Ii

Background: The intervertebral disc has been implicated as an etiology of chronic lumbar spine pain based on clinical, basic science, and epidemiological research. However, there is lack of consensus regarding the diagnosis and treatment of intervertebral disc disorders. Based on controlled evaluations, the lumbar intervertebral discs have been shown to be sources of chronic back pain without disc herniation in 26% to 39%. Lumbar provocation discography, which includes disc stimulation and morphological evaluation, is often used to distinguish a painful disc from other potential sources of pain. Despite the extensive literature, controversy continues about provocation lumbar discography. Study Design: A systematic review of the lumbar provocation discography literature. Objectives: To systematically assess the diagnostic accuracy of lumbar discography. Methods: A systematic review of the literature was performed to assess the diagnostic accuracy of lumbar discography with respect to chronic low back pain. Study inclusion/exclusion criteria were based on International Association for the Study of Pain (IASP) standards with pain provocation and determination of controlled discs. Selected studies were then subjected to a rating instrument for diagnostic accuracy studies. Specific data were then culled from these studies and tabulated. Quality of evidence was assessed using modified Agency for Healthcare Research and Quality (AHRQ) diagnostic accuracy evaluation. Studies meeting methodologic quality criteria scores of 50 or higher were included in the assessment of the level of evidence. Qualitative analysis was conducted using 5 levels of evidence, ranging from Level I to III, with 3 subcategories in Level II. The rating scheme was modified to evaluate the diagnostic accuracy. Results: Based on a modified U.S. Preventive Services Task Force (USPSTF) level of evidence criteria, this systematic review indicates the strength of evidence as Level II-2 for the diagnostic accuracy of lumbar provocation discography utilizing IASP criteria. Limitations: Limitations include a paucity of literature, poor methodologic quality, and very few studies performed utilizing IASP criteria. Conclusion: Based on the current systematic review, lumbar provocation discography performed according to the IASP criteria with control disc (s) with minimum pain intensity of 7 of 10, or at least 70% reproduction of worst pain (i.e. worst spontaneous pain of 7 = 7 x 70% = 5) may be a useful tool for evaluating chronic lumbar discogenic pain. Discography is an important imaging and pain evaluation tool in identifying a subset of patients with chronic low back pain secondary to intervertebral disc disorders. Key words: Chronic low back pain, lumbar intervertebral disc, lumbar discography, provocation discography, pain generator, false-positives, diagnostic accuracy, sensitivity, specificity

Is alcohol intake associated with low back pain? A systematic review of observational studies

2013 ◽  
Vol 18 (3) ◽  
pp. 183-190 ◽  
Author(s):  
Paulo Henrique Ferreira ◽  
Marina Barros Pinheiro ◽  
Gustavo Carvalho Machado ◽  
Manuela Loureiro Ferreira
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Observational Studies ◽  
Alcohol Intake ◽  
Low Back

scholarly journals SHORT-WAVE DIATHERMY IN PATIENTS WITH CHRONIC LOW BACK PAIN: A SYSTEMATIC REVIEW

2020 ◽  
Vol 19 (3) ◽  
pp. 218-222
Author(s):  
LUIS HENRIQUE PALADINI ◽  
NICOLE ALMEIDA ◽  
RACIELE IVANDRA GUARDA KORELO ◽  
RAFAEL MICHEL DE MACEDO ◽  
LUIZ CESAR GUARITA-SOUZA ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Short Wave ◽  
Cochrane Central Register ◽  
Low Back ◽  
Level Of Evidence ◽  
Pulsed Mode ◽  
Central Register

ABSTRACT The aim of this study was to evaluate the evidence of application of short-wave diathermy (SWD) in individuals with chronic low back pain (CLBP) and its prescription parameters. The data sources (MEDLINE, PubMed, LILACS, DARE, PsycINFO, AusportMed, SciELO, PEDro and the Cochrane Central Register of Controlled Trials) were systematically searched for articles published up to December 2017. Randomized and non-randomized clinical trial studies that investigated the effect of the application of SWD on CLBP were selected. Two independent reviewers assessed the risk of bias in studies using the Jadad and the Downs & Black scales. Five studies (731 patients) were included, all of whom presented improvements in CLBP. The majority used continuous mode SWD, with only one using pulsed mode (82 and 200 Hz). SWD produced improvements in CLBP, but there is limited evidence for its application, and a lack of standardization of the parameters used. Furthermore, the results that address this topic should be interpreted with caution due to their low methodological quality and limited number. Level of evidence II; Systematic review.

scholarly journals Prevalence of Occupational Related Upper and Low Back Musculoskeletal Disorders in Ethiopia: Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Dechasa Adare Mengistu ◽  
Yohannes Mulugeta Demmu
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Musculoskeletal Disorders ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Low Back ◽  
Pooled Prevalence ◽  
Study Population ◽  
One Year

Abstract Background: Occupational related musculoskeletal disorders (MSDs) are a major public health problem and result in the growing demands of healthcare service utilization, causing temporary and permanent disability and reduced quality of life. In developing countries, particularly in Ethiopia, there is no adequate evidence on the overall prevalence of occupational-related MSDs and remains less prioritized and empirically unrepresented. Thus, this study aimed to determine the pooled prevalence of occupational-related musculoskeletal disorders, particularly low and upper back musculoskeletal disorders in Ethiopia.Methods: This systematic review and meta-analysis considered studies conducted in Ethiopia, written in the English language, and published from 2017-2020. The articles were searched using the following electronic databases such as Web of Science, SCOPUS, PubMed, Google Scholar, CINAHL, Cochrane Library, African Index Medicus, African Journals Online database, and Science direct using a combination of Boolean logic operators, Medical Subject Headings, and main keywords. Quality assessment of the articles was done using the Joanna Briggs Institute Critical Appraisal tools to determine the relevance of articles to the study.Results: The current study found the pooled prevalence of occupational-related upper back pain and low back pain in the previous one year was 27.1% [95% of CI: 18.4, 37.9%] and 54.2% [95% of CI: 48.2, 60.0%] respectively. However, the pooled prevalence of occupational-related upper back pain in the previous one year after subgroup analysis based on publication year, study population, and study area was 43.8% [95% of CI: 39.3, 47.7%], 34.7%[95% of CI: 33.1, 36.2%] and 36.2% [95% of CI: 33.6, 39.0%] respectively while the pooled prevalence of occupational-related low back pain in previous one year based on subgroup analysis by publication year, study population, and study area was 61.8% [95% of CI: 58.9, 64.6%], 52.8% [95% of CI: 51.3, 54.3%] and 55.2% [95% of CI: 51.4, 59.0%] respectively.Conclusion: This systematic review and meta-analysis found that, more than half of the included study participants were experienced low back pain in the previous year, whereas more than one-fourth of the included participants were experienced upper back pain. Thus, applying occupational health and safety practices in the working environment plays an important role in reducing work-related MSDs and other occupational hazards.

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