Clinical Effectiveness of Conservative Treatments on Lumbar Spinal Stenosis: A Network Meta-Analysis

Chen, Xuanwei; Zheng, Zhizhan; Lin, Jianhua

doi:10.3389/fphar.2022.859296

Cited by 5 publications

(7 citation statements)

References 21 publications

(13 reference statements)

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“…Thus, nonsurgical treatment is appropriate for patients with mild to moderate symptoms. Some of the commonly used treatment strategies include medication, physical therapy, massage, conventional transforaminal epidural steroid injection (CTFESI), selected nerve root block (SNRB), and LRB[ 12 - 17 ]. Medication, physical therapy, and massage are unsatisfactory choices because of their short-term effect and high recurrence rate[ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Novel approach of ultrasound-guided lateral recess block for a patient with lateral recess stenosis: A case report

Yang,

Li,

2024

World J Clin Cases

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BACKGROUND Ultrasound guide technology, which can provide real-time visualization of the needle tip and tissues and avoid many adverse events, is widely used in minimally invasive therapy. However, the studies on ultrasound-guided Lateral recess block (LRB) are limited, this is probably because there is no recognized standard method for ultrasound scanning. This study aimed to evaluate the effect of ultrasound-guided LRB in patients with lateral recess stenosis (LRS). CASE SUMMARY A 65-year-old patient complained of low back pain accompanied occasionally by pain and numbness in the left lower limb. Physical examination showed tenderness on the spinous process and paraspinal muscles from L1 to S1, extensor hallucis longus and tibialis anterior weakness (muscle strength: 4−), and a positive straight leg raising test in the left lower limb (60°). Magnetic resonance imaging showed L4–L5 disc degeneration with left LRS and nerve root entrapment. Subsequently, the patient was diagnosed with LRS. This patient was treated with a novel ultrasound-guided LRB approach. The patient’s symptoms significantly improved without any complications at 1 wk postoperatively and at the 3-month follow-up. CONCLUSION This is the first report on the LRS treatment with ultrasound-guided LRB from the contralateral spinous process along the inner side of the articular process by out-plane technique. Further studies are expected to investigate the efficacy and safety of ultrasound-guided LRB for patients with LRS.

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Section: Discussionmentioning

confidence: 99%

Novel approach of ultrasound-guided lateral recess block for a patient with lateral recess stenosis: A case report

Yang,

Li,

2024

World J Clin Cases

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“…Acupuncture and acupotomy contribute to the LSS patients on pain, symptoms and functional outcomes up to 6 months post-treatment 6 7. Moreover, CM alone or combined treatment is likely to more pronouncedly alleviate pain and ameliorate functional outcomes than conventional therapies 8. Furthermore, manual therapy in combination with exercises under supervision can improve walking capacity, symptoms and pain in comparison to exercises 9…”

Section: Introductionmentioning

confidence: 99%

“…An important effect of the above inconsistencies is to limit the potential of robust meta-analysis. In a network meta-analysis of conservative treatment of LSS, only four results were analysed, while the other results could not be analysed due to the limited data or no meta-analysis to determine the outcome, or the variety of definitions of an outcome 8. Existing problems, supported by most CM trials, include poorly defined outcomes, insufficient evidence of instruments, selective reporting of outcomes or no criteria for selection for core outcomes 11.…”

Section: Introductionmentioning

confidence: 99%

Development of CORE-CM core outcome domain sets for trials of Chinese medicine for lumbar spinal stenosis

Sun,

An,

Weng

et al. 2023

BMJ Open

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ObjectivesMost Asian countries have employed Chinese medicine (CM) and Western medicine to treat lumbar spinal stenosis (LSS). Evidence synthesis and comparison of effectiveness are difficult since outcomes examined and presented through trials possess heterogeneity. This study aimed to solve the outcome problems for CM clinical trials in LSS by building a core outcome set (COS).MethodsTo achieve an agreement on a set of core outcome domains, a four-phase study was carried out. First, we identified candidate outcome domains by systematically reviewing trials. In addition, we identified outcome domains associated with patients by conducting semistructured interviews with patients. Next, outcome domains were processed through a national two-round Delphi survey, in which 18 patients and 21 experts were recruited. Finally, the above domains were converted as a core outcome domain set based on a consensus meeting, in which 24 stakeholders were recruited.ResultsSeventeen outcome subdomains were identified by the systematic review and interviews. The Delphi survey assigned a priority to four outcome domains in the first round and four outcomes additionally in the second round. The core outcome domains were determined through discussion and redefinition of outcomes in the consensus meeting: pain and discomfort, health-related quality of life, lumbar function, activities of daily living, measures of walking, patient global assessment, adverse events and CM-specific outcomes.ConclusionCOS-CM-LSS is likely to enhance the consistency of outcomes reported in clinical trials. In-depth research should be conducted for the exploration of the best methods to examine the above outcomes.

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“…7,8 A network meta-analysis shows that Chinese Herbal Medication (CHM) alone or combined with other treatments might improve pain and functional outcomes better than other treatments. 9 Compared to self-directed or group exercise, manual therapy combined with supervised activities increases short-term walking capacity and moderately reduces pain and symptom severity. 10 For LSS patients with NC, multimodal or comprehensive treatments, such as education, lifestyle modifications, and behavioral change strategies, combined with home exercises, manual therapy, and rehabilitation, maybe first considered.…”

Section: Introductionmentioning

confidence: 99%

A Protocol for a Single-Centered, Pragmatic, Randomized, Controlled, Parallel Trial Comparing Comprehensive Nonsurgical Therapy Options for Individuals with Lumbar Spinal Stenosis

Sun¹,

An²,

Fan³

et al. 2023

JPR

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Lumbar spinal stenosis (LSS) is a long-term degenerative disease. Considering the risks and advantages of the patient's age range and the characteristics of the condition, non-surgical treatment is recommended. To determine the best first-line non-surgical therapy for LSS, few studies have examined different non-surgical therapies. Therefore, the main objective of this study is to determine whether the selection of comprehensive Chinese medicine (CM) treatment for LSS is more successful than non-surgical conservative treatment. Patients and Methods: In this two-armed, parallel, single-centered, pragmatic randomized controlled study, 94 LSS participants will be randomized to receive 24 sessions of comprehensive CM therapy or conservative treatment for 3 months, with follow-up assessments at 6, 9, 12, and 15 months. The primary outcome will be based on the success rate of the Zurich Claudication Questionnaire (ZCQ) for the most clinical important difference (MCID) at 3 and 15 months. Secondary outcomes include Numerical Rating Scale (NRS) scores for back and leg pain, ZCQ scores, Oswestry Disability Index scores for lumbar dysfunction, and Short-Form 12 scores for health-related quality of life at 3, 6, 9, 12, and 15 months. Adverse events and incidences of surgery will be reported anytime during the trial and follow-up. Conclusion: This protocol examines the comparative efficacy of comprehensive CM therapy compared with conventional care through a pragmatic randomized controlled trial to present data to facilitate clinical or policy decision-making. The outcomes will make it easier to decide which patient-centered treatments to prioritize for LSS.

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Clinical Effectiveness of Conservative Treatments on Lumbar Spinal Stenosis: A Network Meta-Analysis

Cited by 5 publications

References 21 publications

Novel approach of ultrasound-guided lateral recess block for a patient with lateral recess stenosis: A case report

Novel approach of ultrasound-guided lateral recess block for a patient with lateral recess stenosis: A case report

Development of CORE-CM core outcome domain sets for trials of Chinese medicine for lumbar spinal stenosis

A Protocol for a Single-Centered, Pragmatic, Randomized, Controlled, Parallel Trial Comparing Comprehensive Nonsurgical Therapy Options for Individuals with Lumbar Spinal Stenosis

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