■确定疗效,有效性,和透视或超声引导下的尾硬膜外类固醇注射(ESI)有或没有导管放置治疗慢性腰背(CLBP)的安全性,神经根疼痛,和/或慢性手术后背痛(CPSBP)。
■系统评价。
■患有CLBP的成年人≥18岁,神经根疼痛,或CPSBP≥3个月。
■透视或超声引导的尾部ESI,无论是否使用导管,包括硬膜外神经成形术。
■Sham,安慰剂程序,积极的标准护理治疗,或者没有。
■主要结果是疼痛减轻≥50%的个体比例。次要结果包括功能改善,镇痛药的使用,随后的脊柱手术,医疗保健利用,意味着疼痛的改善。报告的不良事件也被编目。
■四位审稿人在2022年1月2日之前在PubMed独立评估出版物,OvidMEDLINE,还有Scopus.使用推荐标准对证据质量进行评估,评估,发展,和评估(等级)框架。
■筛选的364条记录中,23份出版物符合纳入标准。主要结局的成功率只能从一项研究中推断出来。另一项研究使用了包括疼痛和功能结果的复合改善量表。这两项研究报告的成功率在三个月时从40%到58%不等,六个月时25%-67%,一年的58%-61%。次要结果的数据有限;然而,通过Oswestry残疾指数(ODI)的平均改善来衡量的功能改善率范围为2%至55%。
■有中等质量的证据表明,使用留置导管两天的尾部ESI是治疗与椎间盘突出症和神经根疼痛相关的疼痛和功能障碍的有效方法,六,和12个月。有低质量的证据支持其他尾管ESI技术治疗中央腰椎管狭窄伴神经源性跛行的疼痛和功能障碍的有效性。盘源性CLBP,和CLBP无椎间盘突出或神经根炎。
UNASSIGNED: Determine the efficacy, effectiveness, and safety of fluoroscopically- or ultrasound-guided caudal epidural steroid injections (ESIs) with or without catheter placement for the treatment of chronic low back (CLBP), radicular pain, and/or chronic post-surgical back pain (CPSBP).
UNASSIGNED: Systematic review.
UNASSIGNED: Adults ≥18 years with CLBP, radicular pain, or CPSBP ≥3 months.
UNASSIGNED: Fluoroscopically- or ultrasound-guided caudal ESI with or without a catheter including epidural neuroplasty.
UNASSIGNED: Sham, placebo procedure, active standard care treatment, or none.
UNASSIGNED: The primary outcome was the proportion of individuals with reduction of pain by ≥ 50%. Secondary outcomes included functional improvement, analgesic use, subsequent spinal surgery, healthcare utilization, and mean improvement in pain. Reported adverse events were also cataloged.
UNASSIGNED: Four reviewers independently assessed publications before January 2, 2022 in PubMed, Ovid MEDLINE, and Scopus. Quality of evidence was evaluated using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework.
UNASSIGNED: Of 364 records screened, 23 publications met inclusion criteria. The success rates for the primary outcome could only be extrapolated from one study. Another study used a composite improvement scale that included pain and functional outcomes. The reported success rates in these two studies ranged from 40 to 58% at three months, 25%-67% at six months, and 58%-61% at one year. Data on secondary outcomes were limited; however, rates of functional improvement as measured by mean improvement in Oswestry Disability Index (ODI) ranged from 2% to 55%.
UNASSIGNED: There is moderate-quality evidence that caudal ESIs using an in-dwelling catheter for two days is an effective treatment for pain and dysfunction associated with disc herniation with radicular pain and for CPSBP at three, six, and 12 months. There is low-quality evidence supporting the effectiveness of other caudal ESI techniques for pain and dysfunction associated with central lumbar spinal stenosis with neurogenic claudication, discogenic CLBP, and CLBP without disc herniation or radiculitis.