Systematic Review and Meta-analysis of Efficacy and Safety of Tenghuang Jiangu Tablet(藤黄健骨片)in the Treatment of Discogenic Low Back Pain

Objective:To systematically evaluate the efficacy and safety of Tenghuang Jiangu Tablet(藤黄健骨片)in the treatment of discogenic low back pain.Methods:CNKI,WanFang,CBM,VIP,PubMed,EMbase,Cochrane Library and Web of Science were systematically searched to collect the randomized controlled trials(RCTs)of Tenghuang Jiangu Tablet in the treatment of discogenic low back pain.Literature screening and data extraction according to the set criteria were conducted.Cochrane Risk Bias assessment tool was used to evaluate the quality of included RCTs,and Meta-analysis was performed using RevMan 5.4.1 software.Results:A total of 4 studies were included,with a total sample size of 404 cases.The results of Meta-analysis suggested that Tenghuang Jiangu Tablet combined with conventional treatment in the treatment of discogenic low back pain was superior to conventional treatment alone in terms of total clinical response rate(RR=1.21,95%CI[1.09,1.35],P=0.0004),excellent rate of curative effect(RR=1.24,95%CI[1.10,1.41],P=0.0007),lower VAS score(MD=-0.62,95%CI[-0.79,-0.44],P<0.00001)and JOA score(MD=1.84,95%CI[1.35,2.33],P<0.00001).There was no statistical significance in the incidence of adverse reactions between Tenghuang Jiangu Tablet combined with conventional treatment and conventional treatment alone(RR=0.76,95%CI[0.04,15.42],P=0.86).Conclusion:Based on existing research and methods,Tenghuang Jiangu Tablet combined with conventional therapy is effective on discogenic low back pain.Conventional therapy combined with Tenghuang Jiangu Tablet for the treatment of discogenic low back pain may be better than conventional therapy alone.All the adverse reactions occurred during the treatment were mild.There is no evidence that Tenghuang Jiangu Tablet can cause serious adverse reactions.However,the number of existing clinical studies is small and the quality is generally not high.It is suggested to carry out more large-sample and high-quality RCTs,and pay more attention to the long-term efficacy of drugs and the occurrence of adverse reactions,so as to further verify the above conclusions.

Imaging of low back pain： comparative role of high intensity zone in diagnosing the discogenic low back pain with evidence-based radiology

Background Discography is a gold standard for the diagnosis of the low back pain （LBP）, but it has potential dangers for the development of discitis, cerebral spinal fluid leakage, retroperitoneal bleeding, acute new back pain and the tremendous radiation exposure to the patient. Using ＂evidence-based radiology＂ methods, the comparative roles of high intensity zone （HIZ） in diagnosing discogenic LBP were evaluated. Methods A focused clinical question was designed and a Pubmed and manual search were performed to identify the role of HIZ on MRI T2WI compared with discography. The studies retrieved were assessed for validity and strength. Sensitivity, specificity, likelihood ratios （LRs） and graphs of conditional probability were evaluated from the best current study by evidence-based radiology. Results Best evidence was retrieved in ten articles from 1992 to 2007. The best evidence level was lb and the strength of the evidence included： sensitivity 0.63 （0.51,0.76）, specificity 0.97 （0.92, 1.00）, positive predictive value 0.95, negative predictive value 0.72, positive LRs 18.37 and negative LRs 0.38. The gold standard of discogenic LBP is the provocative discography. Conclusions For suspected discogenic LBP, HIZ is limited for the diagnosis if HIZ is positive, which suggests further discography. In contrast HIZ is a good test for diagnosis if HIZ is negative, which indicates the disease can be excluded.

Fluoroscopy-guided Bipolar Radiofrequency Thermocoagulation Treatment for Discogenic Low Back Pain

Background：The efficacy of percutaneous intradiscal radiofrequency thermocoagulation （PIRFT） for the treatment of discogenic low back pain （LBP） remains controversial.However,all the PIRFT studies utilized monopolar radiofrequency thermocoagulation （RFTC）.The aim of this study was to investigate the safety and efficacy of bipolar RFTC for the treatment of discogenic LBP.Methods：A total of 23 patients with discogenic LBP were treated with single-level bipolar RFTC.The patients were assessed before the procedure and at 1 week,1 month,3 months,6 months,and 1 year after the procedure.The primary outcome included the visual analog scale （VAS） score and the Oswestry Disability Index （ODI） score.The secondary outcome included pain relief,reduction of analgesic dose,and patient satisfaction.Results：The VAS and ODI scores were significantly decreased after bipolar RFTC treatment at all time points of follow-up （P 〈 0.05）.Bipolar RFTC treatment also resulted in a significant change in all secondary measures,such as pain relief,reduction of analgesic dose,and patient satisfaction.No serious complications or neurological sequelae were observed in any of the patients.Conclusions：Bipolar RFTC treatment can significantly attenuate pain and improve the function of patients with discogenic LBP.

Percutaneous Nucleoplasty Using Coblation Technique for the Treatment of Chronic Nonspecific Low Back Pain： 5-year Follow-up Results

Background： This study evaluated the efficacy of percutaneous nucleoplasty using coblation technique for the treatment of chronic nonspecific low back pain （LBP）, after 5 years of follow-up. Methods： From September 2004 to November 2006, 172 patients underwent percutaneous nucleoplasty for chronic LBP in our department. Forty-one of these patients were followed up for a mean period of 67 months. Nucleoplasty was performed at L3/4 in 1 patient; L4/5 in 25 patients; L5/$1 in 2 patients; L3/4 and L4/5 in 2 patients; L4/5 and L5/$1 in 7 patients; and L3/4, L4/5, and L5/$1 in 4 patients. Patients were assessed preoperatively and at 1 week, 1 year, 3 years, and 5 years postoperatively. Pain was graded using a 10-cm Visual Analogue Scale （VAS） and the percentage reduction in pain score was calculated at each postoperative time point. The Oswestry Disability Index （ODI） was used to assess disability-related to lumbar spine degeneration, and patient satisfaction was assessed using the modified MacNab criteria. Results： There were significant differences among the preoperative, 1-week postoperative, and 3-year postoperative VAS and ODI scores, but not between the 3- and 5-year postoperative scores. There were no significant differences in age, sex, or preoperative symptoms between patients with effective and ineffective treatment, but there were significant differences in the number of levels treated, Pfirrmann grade of intervertebral disc degeneration, and provocative discography findings between these two groups. Excellent or good patient satisfaction was achieved in 87.9% of patients after 1 week, 72.4% after 1 year, 67.7% after 3 years, and 63.4% at the last follow-up. Conclusions： Although previously published short- and medium-term outcomes after percutaneous nucleoplasty appeared to be satisfactory, our long-term follow-up results show a significant decline in patient satisfaction over time. Percutaneous nucleoplasty is a safe and simple technique, with therapeutic effectiveness for the treatment of chronic LBP in selected patients. The technique is minimally invasive and can be used as part of a stepwise treatment plan for chronic LBP.