A systematic review of systematic reviews of management of lumbar disc herniation

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Abstract text
Background: Patients with lumbar disc herniation are treated by different management. There is no overview of systematic reviews s on these interventions.
Objectives: To summarize recent systematic reviews from any interventions for patients with lumbar disc herniation.
Methods:Literature searches were carried out through six electronic Databases for all systematic reviews of management for lumbar disc herniation,published between 1978 and October 2011.
Results and Conclusions: In total 37 studies were identified, 12 of which were with low risk of bias. Six studies compared different surgeries with conservative management. There is considerable evidence that surgical discectomy provides effective clinical relief for carefully selected patients that fails to resolve with conservative management.However,no significant differences were found between surgery and conservative care in any of the clinical outcomes after 1 to 2 years.22 studies compared different surgeries. There were no significant differences in the treatment outcome and the operation time between standard discectomy and microendoscopy discectomy; microendoscopy discectomy was superior to open lumbar disectomy in intraoperative blood loss, time in hospital and the time out of bed after operation. There was strong evidence for transforaminal injections in the treatment of lumbosacral radicular pain for both short term and long term relief.The evidence for other minimally invasive techniques such as chemonucleolysis, automated percutaneous discectomy, nucleoplasty, oxygen/ozone and laser discectomy remains unclear except those not provided valid information to either support or refute using them.11 studies compared different Traditional Chinese Medicine(TCM) management. There was evidence that TCM treatment on lumbar disc herniation is safe and effective, but the methodological quality of these studies was poor,and the conclusion remained uncertain. Future studies should evaluate economic indicators among different interventions.
Authors
Xue L1, Li Y1, He L2, Zha L3, Li K4
1 Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu ,P.R. China
2 Books & Inforation Center of West China Hospital, Sichuan University, Chengdu , P.R.China
3 Department of Gynaecology and Obstetrics, Chengdu Women’s & Childen’s Central Hospital, Chengdu Sichuan, P.R.Chin
4 Department of Orthopaedics, Chengdu Third People’s Hospital, Chengdu Sichuan,P.R. China
Presenting author and contact person
Presenting author: 
li xue
Contact person Affiliation Country
li xue (Contact this person) Chinese Cochrane Center China