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Total disk replacement was found to be the most
effective treatment amongst the four treatments compared in this study.
However, all treatments provided some benefit to the patients with LBP.
Around 60% - 80% adults experience low back pain (LBP) at some point throughout their lifetime. Various treatment options are available for LBP management, but it is crucial to issue an evidence-based assessment for these options.
Rihn JA and colleagues performed a systematic review and network
meta-analysis to investigate the current treatment options of LBP as per
randomized controlled trials (RCTs). The effectiveness was compared using the
mixed-treatment comparison (MTC).
MEDLINE and the Cochrane Collaboration Library were systematically
searched for the RCTs from 1990 to 2014. Preoperative and postoperative ODI and
VAS back pain scores, additional surgeries, and complications were extracted
from the specified studies. Standard and network meta-analytic techniques were
manipulated.
A total of 12 RCTs were inculcated in the investigation: 5 fusion
versus exercise and CBT; 5 total disk replacement (TDR) versus fusion; 1 TDR
versus exercise and cognitive behavioral therapy (CBT); and 1 fusion versus physical therapy (PT).
The pooled mean difference supporting fusion over exercise and CBT was 2.0
points on the basis of MTC, concerning the ODI change scores. The pooled mean
difference favoring TDR over exercise and CBT, and TDR over fusion was 6.4 points
and 4.4 points. The pooled mean differences favoring fusion over PT
resulted in 8.8 points. For PT versus structured
exercise with CBT, the pooled mean difference favouring exercise with CBT over
PT was 6.8 points and for TDR versus PT, favouring TDR over PT was 13.2 points.
Between different treatments, additional surgery rates were related.
Therefore, all the four mentioned treatments imparted some advantages in chronic LBP patients. Further, as reported by MTC analysis, The TDR may be the most efficient treatment. Whereas, the PT may be the least efficient treatment for chronic LBP management.
Clin Spine Surg. 2017 Jun;30(5):204-225
Comparative Effectiveness of Treatments for Chronic Low Back Pain: A Multiple Treatment Comparison Analysis
Rihn JA et al.
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