Comparison of interventions for lumbar disc herniation: a systematic review with network meta-analysis

Rickers, K; Pedersen, Peter Heide; Tvedebrink, Torben; Eiskjær, Søren Peter

doi:10.1016/j.spinee.2021.02.022

Cited by 22 publications

(21 citation statements)

References 55 publications

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“…The finding of this study agrees with the previous reviews63–65 which showed that non-surgical treatments did not yield better effects than surgical treatments in patients with LDH, especially at long-term follow-up. However, we should bear in mind that our study focused on MCT only to provide a thorough understanding of the effectiveness of this exercise and the small number of homogeneous studies did not permit us to collate conclusive evidence about MCT for patients with symptomatic LDH.…”

Section: Discussionsupporting

confidence: 92%

Does motor control training improve pain and function in adults with symptomatic lumbar disc herniation? A systematic review and meta-analysis of 861 subjects in 16 trials

et al. 2022

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ObjectiveTo evaluate the effectiveness of motor control training (MCT) compared with other physical therapist-led interventions, minimal/no intervention or surgery in patients with symptomatic lumbar disc herniation (LDH).DesignSystematic review and meta-analysis.Data sourcesEight databases and the ClinicalTrials.gov were searched from inception to April 2021.Eligibility criteriaWe included clinical trial studies with concurrent comparison groups which examined the effectiveness of MCT in patients with symptomatic LDH. Primary outcomes were pain intensity and functional status which were expressed as mean difference (MD) and standardised mean difference (SMD), respectively.ResultsWe screened 6695 articles, of which 16 clinical trials (861 participants) were eligible. Fourteen studies were judged to have high risk of bias and two studies had some risk of bias. In patients who did not undergo surgery, MCT resulted in clinically meaningful pain reduction compared with other physical therapist-led interventions (ie, transcutaneous electrical nerve stimulation (TENS)) at short-term (MD –28.85, –40.04 to −17.66, n=69, studies=2). However, the robustness of the finding was poor. For functional status, a large and statistically significant treatment effect was found in favour of MCT compared with traditional/classic general exercises at long-term (SMD −0.83 to –1.35 to −0.31, n=63, studies=1) and other physical therapist-led interventions (ie, TENS) at short-term (SMD −1.43 to –2.41 to −0.46, n=69, studies=2). No studies compared MCT with surgery. In patients who had undergone surgery, large SMDs were seen. In favour of MCT compared with traditional/classic general exercises (SMD −0.95 to –1.32 to −0.58, n=124, studies=3), other physical therapist-led interventions (ie, conventional treatments; SMD −2.30 to –2.96 to −1.64, n=60, studies=1), and minimal intervention (SMD −1.34 to –1.87 to −0.81, n=68, studies=2) for functional improvement at short-term. The overall certainty of evidence was very low to low.ConclusionAt short-term, MCT improved pain and function compared with TENS in patients with symptomatic LDH who did not have surgery. MCT improved function compared with traditional/classic general exercises at long-term in patients who had undergone surgery. However, the results should be interpreted with caution because of the high risk of bias in the majority of studies.PROSPERO registration numberCRD42016038166.

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Section: Discussionsupporting

confidence: 92%

Does motor control training improve pain and function in adults with symptomatic lumbar disc herniation? A systematic review and meta-analysis of 861 subjects in 16 trials

et al. 2022

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“…LDH, affecting 1%-5% of the population per year, 34 is commonly caused by intervertebral disc degeneration (IDD), which is involved in complex and multifactorial processes. 35 , 36 IDD, characterized by dehydration of the central nucleus, annular disruption, and decreases in proteoglycan content, cellularity, and endplate density, 37 is closely associated with the dysregulation of ECM homeostasis.…”

Section: Introductionmentioning

confidence: 99%

Single-cell RNA sequencing in orthopedic research

et al. 2023

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Although previous RNA sequencing methods have been widely used in orthopedic research and have provided ideas for therapeutic strategies, the specific mechanisms of some orthopedic disorders, including osteoarthritis, lumbar disc herniation, rheumatoid arthritis, fractures, tendon injuries, spinal cord injury, heterotopic ossification, and osteosarcoma, require further elucidation. The emergence of the single-cell RNA sequencing (scRNA-seq) technique has introduced a new era of research on these topics, as this method provides information regarding cellular heterogeneity, new cell subtypes, functions of novel subclusters, potential molecular mechanisms, cell-fate transitions, and cell‒cell interactions that are involved in the development of orthopedic diseases. Here, we summarize the cell subpopulations, genes, and underlying mechanisms involved in the development of orthopedic diseases identified by scRNA-seq, improving our understanding of the pathology of these diseases and providing new insights into therapeutic approaches.

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“…The most common non-pharmacological treatments include exercise therapy, massage, acupuncture, and psychological intervention. However, the efficacy of these treatments lacks robust evidence and well-designed cohort studies ( Rickers et al, 2021 ). In addition, there is also a lack of valid comparative studies between different treatment modalities.…”

Section: Introductionmentioning

confidence: 99%

Natural products can modulate inflammation in intervertebral disc degeneration

Liu

Zhu²,

Liu³

et al. 2023

Front. Pharmacol.

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Intervertebral discs (IVDs) play a crucial role in maintaining normal vertebral anatomy as well as mobile function. Intervertebral disc degeneration (IDD) is a common clinical symptom and is an important cause of low back pain (LBP). IDD is initially considered to be associated with aging and abnormal mechanical loads. However, over recent years, researchers have discovered that IDD is caused by a variety of mechanisms, including persistent inflammation, functional cell loss, accelerated extracellular matrix decomposition, the imbalance of functional components, and genetic metabolic disorders. Of these, inflammation is thought to interact with other mechanisms and is closely associated with the production of pain. Considering the key role of inflammation in IDD, the modulation of inflammation provides us with new options for mitigating the progression of degeneration and may even cause reversal. Many natural substances possess anti-inflammatory functions. Due to the wide availability of such substances, it is important that we screen and identify natural agents that are capable of regulating IVD inflammation. In fact, many studies have demonstrated the potential clinical application of natural substances for the regulation of inflammation in IDD; some of these have been proven to have excellent biosafety. In this review, we summarize the mechanisms and interactions that are responsible for inflammation in IDD and review the application of natural products for the modulation of degenerative disc inflammation.

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Comparison of interventions for lumbar disc herniation: a systematic review with network meta-analysis

Cited by 22 publications

References 55 publications

Does motor control training improve pain and function in adults with symptomatic lumbar disc herniation? A systematic review and meta-analysis of 861 subjects in 16 trials

Does motor control training improve pain and function in adults with symptomatic lumbar disc herniation? A systematic review and meta-analysis of 861 subjects in 16 trials

Single-cell RNA sequencing in orthopedic research

Natural products can modulate inflammation in intervertebral disc degeneration

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