Purpose We aimed to assess the global, regional, and national burdens of low back pain (LBP) from 1990 to 2019 by gender, age, and the sociodemographic index (SDI) from the Global Burden of Disease (GBD) 2019 study. Methods The number of incident cases, disability-adjusted life years (DALYs), age-standardized incidence rates, and age-standardized DALY rates during 1990–2019 were obtained from the GBD 2019 study. The estimated annual percentage changes (EAPCs) in the age-standardized incidence rates and age-standardized DALY rates were determined to measure the temporal trends of LBP. Results In 2019, there were an estimated 223.5 million cases of LBP and 63.7 million LBP-related DALYs worldwide. During 1990–2019, the age-standardized incidence rate [EAPC = − 0.41; 95% confidence interval (CI) − 0.46 to − 0.36] and age-standardized DALY rate decreased (EAPC = − 0.51; 95% CI − 0.56 to − 0.46) globally. The age-standardized incidence rate of LBP decreased the most in low-middle SDI regions. The age-standardized incidence rate of LBP decreased the most in South Asia (EAPC, − 1.51), East Asia (EAPC, − 0.68), and Australasia (EAPC, − 0.26). The incidence in male subjects was lower than that in female subjects. The largest decreases in the age-standardized incidence rate and age-standardized DALY rate of LBP were observed in India, and China. Conclusions The global age-standardized incidence rate and age-standardized DALY rate of LBP showed a downward trend, especially in East and South Asia. In addition, a heavier burden of LBP was observed in older and female populations.
This network meta‐analysis aims to evaluate the comparative effectiveness and safety of suture anchors (SA), tendon grafts (TG), hook plates (HP), Tight‐Rope (TR), and EndoButton (EB) in the treatment of acute acromioclavicular joint (ACJ) dislocation. The Embase, PubMed, and Web of Science databases were searched from their inception date to June 3, 2022. Studies included all eligible randomized controlled trials (RCTs) and cohort studies with the comparison of five different fixation systems among SA, TG, HP, TR, and EB were identified. All studies were reviewed, performed data extraction, and assessed the risk of bias independently by two reviewers. The primary outcomes are Constant–Murley score (CMS) improvement for assessing clinical efficacy, and complications. The second outcomes are visual analog scale (VAS) for assessing pain relief and the coracoclavicular distance (CCD) for assessing postoperative joint reduction. Version 2 of the revised Cochrane risk of bias tool for randomized trials (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS‐I) were used to assess the RCTs and non‐randomized trials, respectively. The continuous outcomes were presented as mean differences (MD), and risk ratios (OR) were used for dichotomous outcomes, both with 95% confidence intervals (CI). Surface under the cumulative ranking curves (SUCRA) results were calculated to offer a ranking of each intervention. We identified 31 eligible trials, including 1687 patients in total. HP showed less CMS improvement than TR and EB in both the Network Meta‐analysis (NMA) and pairwise meta‐analysis. HP also showed less CMS improvement than SA in NMA. For pain relief, HP performed worse than TR both in pairwise meta‐analysis and NMA. No significant differences were found for the measured value of CCD. Both TR and EB showed a lower incidence of complications than HP in pairwise meta‐analysis. The rank of SUCRA for CMS improvement was as follows: SA, TR, EB, TG, and HP; for pain relief: TR, EB, TG, SA, and HP; for CCD: HP, TR, SA, EB, and TG. For complications, HP showed the highest rank, followed by TG, EB, TR, and SA. SA shows better clinical effectiveness and reliable safety in the treatment of acute ACJ dislocation. Although HP is the most widely used surgical option currently, it should be carefully taken into consideration for its high incidence of complications.
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