加拿大麦克马斯特大学Liang Yao研究小组分析了慢性非癌性脊柱疼痛的常见介入治疗方法的相对有效性。该研究于2025年2月19日发表在《英国医学杂志》上。

为了探讨慢性非癌性（轴性或根性）脊柱疼痛常用介入治疗的相对有效性，研究组对Medline、Embase、CINAHL、CENTRAL和Web of Science从成立到2023年1月24日检索随机对照试验（RCTs）的系统评价和网络荟萃分析（NMA）。纳入慢性非癌性脊柱疼痛患者的随机对照试验，随机接受常用的介入手术与假手术、常规护理或其他介入手术。成对的审评员独立确定了符合条件的研究，提取了数据，并评估了偏倚风险。研究组进行了频率论网络荟萃分析来总结证据，并使用GRADE方法来评估证据的确定性。

在132项符合条件的研究中，荟萃分析包括81项试验，涉及7977名患者，探讨了13种介入手术或手术组合。所有后续影响均指与假手术的比较。对于慢性轴性脊柱疼痛，以下可能在疼痛缓解方面几乎没有差异（中等确定性证据）：硬膜外注射局部麻醉剂（加权平均差（WMD）0.28 cm，10 cm视觉模拟量表（95%CI-1.18至1.75）），硬膜外注射局部麻醉剂和类固醇（WMD 0.20（-1.11至1.51）），以及关节靶向类固醇注射（WMD 0.83（-0.26至1.93））。

肌肉内注射局部麻醉剂（WMD-0.53（-1.97至0.92））、硬膜外注射类固醇（WMD 0.39（-0.94至1.71））、联合靶向注射局部麻醉剂（WMD 0.63（-0.57至1.83））和联合靶向注入局部麻醉剂与类固醇（WMD 0.22（-0.42至0.87））可能在疼痛缓解方面几乎没有差异（低确定性证据）；肌肉注射局部麻醉剂和类固醇可能会增加疼痛（WMD 1.82（-0.29至3.93））（低确定性证据）。联合射频消融的证据被证明非常不确定。

对于慢性根性脊柱疼痛，硬膜外注射局部麻醉剂和类固醇（WMD−0.49（−1.54至0.55））和背根神经节射频（WMD 0.15（−0.98至1.28））可能在缓解疼痛方面几乎没有差异（中等确定性证据）。硬膜外注射局部麻醉剂（WMD-0.26（-1.37至0.84））和硬膜外注射类固醇（WMD-0.56（-1.30至0.17））在缓解疼痛方面可能几乎没有差异（低确定性证据）。

研究结果表明，该NMA随机试验提供了低到中等确定性的证据，表明与假手术相比，轴性或神经根性慢性非癌性脊柱疼痛的常规介入手术可能几乎无法缓解疼痛。

附：英文原文

Title: Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomised trials

Author: Xiaoqin Wang, Grace Martin, Behnam Sadeghirad, Yaping Chang, Ivan D Florez, Rachel J Couban, Fatemeh Mehrabi, Holly N Crandon, Meisam Abdar Esfahani, Laxsanaa Sivananthan, Neil Sengupta, Elena Kum, Preksha Rathod, Liang Yao, Rami Z Morsi, Stéphane Genevay, Norman Buckley, Gordon H Guyatt, Y Raja Rampersaud, Christopher J Standaert, Thomas Agoritsas, Jason W Busse

Issue&Volume: 2025/02/19

Abstract:

Objective To address the comparative effectiveness of common interventional procedures for chronic non-cancer (axial or radicular) spine pain.

Design Systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs).

Data sources Medline, Embase, CINAHL, CENTRAL, and Web of Science from inception to 24 January 2023.

Study selection RCTs that enrolled patients with chronic non-cancer spine pain, randomised to receive a commonly used interventional procedure versus sham procedure, usual care, or another interventional procedure.

Data extraction and synthesis Pairs of reviewers independently identified eligible studies, extracted data, and assessed risk of bias. We conducted frequentist network meta-analyses to summarise the evidence and used the GRADE approach to rate the certainty of evidence.

Results Of 132 eligible studies, 81 trials with 7977 patients that explored 13 interventional procedures or combinations of procedures were included in meta-analyses. All subsequent effects refer to comparisons with sham procedures. For chronic axial spine pain, the following probably provide little to no difference in pain relief (moderate certainty evidence): epidural injection of local anaesthetic (weighted mean difference (WMD) 0.28cm on a 10cm visual analogue scale (95% CI 1.18 to 1.75)), epidural injection of local anaesthetic and steroids (WMD 0.20 (1.11 to 1.51)), and joint-targeted steroid injection (WMD 0.83 (0.26 to 1.93)). Intramuscular injection of local anaesthetic (WMD 0.53 (1.97 to 0.92)), epidural steroid injection (WMD 0.39 (0.94 to 1.71)), joint-targeted injection of local anaesthetic (WMD 0.63 (0.57 to 1.83)), and joint-targeted injection of local anaesthetic with steroids (WMD 0.22 (0.42 to 0.87)) may provide little to no difference in pain relief (low certainty evidence); intramuscular injection of local anaesthetic with steroids may increase pain (WMD 1.82 (0.29 to 3.93)) (low certainty evidence). Evidence for joint radiofrequency ablation proved of very low certainty.

For chronic radicular spine pain, epidural injection of local anaesthetic and steroids (WMD 0.49 (1.54 to 0.55)) and radiofrequency of dorsal root ganglion (WMD 0.15 (0.98 to 1.28)) probably provide little to no difference in pain relief (moderate certainty evidence). Epidural injection of local anaesthetic (WMD 0.26 (1.37 to 0.84)) and epidural injection of steroids (WMD 0.56 (1.30 to 0.17)) may result in little to no difference in pain relief (low certainty evidence).

Conclusion Our NMA of randomised trials provides low to moderate certainty evidence that, compared with sham procedures, commonly performed interventional procedures for axial or radicular chronic non-cancer spine pain may provide little to no pain relief.

DOI: 10.1136/bmj-2024-079971

Source: https://www.bmj.com/content/388/bmj-2024-079971