| Background:Lumbar disc herniation caused by disc degeneration is a common cause of lumbar and leg pain in spinal surgery.In recent years,with the change of lifestyle and the increasing number of elderly people,the incidence of lumbar disc herniation has also increased year by year,seriously affects the quality of life of patients.At present,there are various treatment methods,but mainly conservative treatment and surgical treatment.In cases where conservative treatment is ineffective,patients often require surgery.However,for patients with lumbar disc herniation with Modic changes(MCh),whether to adopt fusion therapy is controversial.Objective:Based on the quantitative synthesis of previous related literatures,the differences in the efficacy of intervertebral fusion or nucleus pulposus extraction in the treatment of patients with lumbar disc herniation with Modic changes were systematically evaluated to provide evidence-based medical evidence for their treatment.Methods:The computer searched China HowNet,Wanfang,Weipu Periodical Database,China Biomedical Literature Service System,PubMed,The Cochrane Library,Embase and other databases.The search time limit is from the time when each database was built to October 2019.Retrieve related magazines manually.Included were published clinical studies on intervertebral fusion and nucleus pulpectomy for the treatment of lumbar disc herniation with Modic changes.The experimental group was the intervertebral fusion treatment group,and the control group was the nucleus pulpectomy treatment group.The quality of the included literature was evaluated according to the Newcastle-Ottawa Scale(NOS)and the Cochrane bias risk assessment tool,and Meta analysis of the literature data was performed with Revman5.3 software.Results:This study finally included 10 studies,a total of 1037 patients with Modic changes in lumbar disc herniation,including 538 patients in the experimental group and 499 patients in the control group.Meta analysis results show that compared with the control group,the experimental group can reduce the patient’s low back pain visual analog scale(VAS)score [MD =-0.83,95% CI(-1.13,-0.54),P <0.00001];reduce Modic Low back pain VAS score of type I patients [MD =-0.94,95% CI(-1.52,-0.35),P = 0.002];lower back pain VAS score of Modic type II patients [MD =-0.75,95% CI(-1.27,-0.24),P = 0.004];However,there was no statistical difference between the two groups of patients with Modic III with low back pain VAS scores [MD =-0.30,95% CI(-0.77,0.16),P = 0.20];in the experimental group There was no statistically significant difference in VAS scores for low back pain between Modic I and Modic II patients [MD =-0.18,95% CI(-0.62,0.26),P = 0.42].There was no statistical difference in the leg pain VAS score between the experimental group and the control group [MD = 0.00,95% CI(-0.13,0.14),P = 0.97];there was no statistical difference between the two groups in the leg pain VAS score of Modic II patients.The difference was [MD = 0.01,95% CI(-0.12,0.13),P = 0.93];the VAS score of leg pain in Modic I patients in the experimental group was lower than that in the control group,and there was a statistical difference,[MD =-0.13 95% CI(-0.25,-0.01),P = 0.03];The VAS score of leg pain in Modic III patients in the experimental group was higher than that in the control group,[MD = 0.76,95% CI(0.03,1.48),P = 0.04];in the experimental group,there was no statistical difference in leg pain VAS scores between Modic I and Modic II patients [MD = 0.03,95% CI(-0.13,0.19),P = 0.73].The test group can reduce the Oswestry Dysfunction Index(ODI)score of patients [MD =-2.08,95% CI(-3.31,-0.86),P = 0.0009];reduce the ODI score of Modic I patients [MD =-2.08,95% CI(-3.31,-0.86),P = 0.0009];Reduce ODI score of Modic type II patients [MD =-1.55,95% CI(-2.88,-0.23),P = 0.02];Modic type III patients ODI scores were not statistically different between the two groups [MD =-0.34,95% CI(-2.66,1.99),P = 0.78];in the experimental group,there was no statistical difference in ODI scores between Modic I and Modic II patients [MD =-0.44,95% CI(-1.18,0.30),P = 0.24].Compared with the control group,the experimental group was able to increase the lumbar JOA score of the patients [MD = 2.32,95% CI(0.32,4.32),P = 0.02].The test group was able to reduce the recurrence of patients [OR = 0.05,95% CI(0.01,0.24),P = 0.0003].There was no statistical difference between the two groups in MacNab criteria postoperatively [OR = 2.83,95% CI(0.95,8.44),P = 0.06].Conclusion:1.Current evidence shows that intervertebral fusion treatment can more effectively reduce low back pain in patients with Modic I and II.2.Intervertebral fusion therapy can more effectively reduce leg pain in patients with Modic I,but the effect of nucleotomy for patients with Modic III in reducing leg pain is more obvious.3.Intervertebral fusion therapy can more effectively reduce the ODI score of Modic I and II patients.4.Intervertebral fusion therapy can improve the JOA score of patients,and the difference between the two groups is significant.5.The results showed that the rate of postoperative recurrence was higher in the nucleus pulposus group than in the interbody fusion group,and the difference between the two groups was significant.6.The results showed that there was no significant difference in the MacNab standard evaluation results between the two groups.7.The overall quality of the included literature is not high and there are risks of publication bias.Therefore,the above conclusions still need to be verified by more high-quality,large-sample,multi-center clinical trials. |
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