| Objective:Nowadays patients diagnosed with failed back surgery syndrome are increasing.Failed back surgery syndrome is characterized by long-term low back pain,this problem is one of the problems in the field of rehabilitation medicine and physiotherapy.Among the many treatment programs,clinical trials of spinal cord stimulation are more in number and more standardized,but the efficacy of this treatment is still controversial.This article use systematic review and meta-analysis in evidence-based medicine to conduct a study about randomized controlled trial of spinal cord stimulation for failed back surgery syndrome,to explore the efficacy of spinal cord stimulation,and to provide a reference for the rehabilitation programs for patients with failed back surgery syndrome.Method:Search Pubmed,Cochrane Library,EMbase,Chinese National Knowledge Infrastructure Databases,Wanfang,VIP,Chinese Biomedical Literature Database,systematically collected randomized controlled trials of spinal cord stimulation for failed back surgery syndrome.Two investigators were screened independently according to the exclusion criteria,the re-screening was carried out to ensure that the Chinese and foreign documents are not missed,then extracted basic information of the final literature.Methodological quality assessment of the included studies was based on the Cochrane Bias Risk Assessment Tool.Meta-analysis two indicators of low back pain intensity and lumbar function by using Revman 5.3 software.Result:1.Bias risk assessment resultsOverall,the Cochrane bias risk assessment results of the five studies were good,the risk of bias was low,and the quality of the included studies was high.2.Search results758 related articles was searched,12 documents that may meet the requirements was selected,5 documents that meet the requirements finally included.3.Meta analysis results(1)Regarding the low back pain intensity score,5 RCTs were included in the study,totaling 173 patients.Heterogeneity test results: I2 = 72%,using a random effects model.Combined effect amount: SMD=-0.99,95% CI [-1.61,-0.37],test of combined effect amount: z=3.12,P=0.002<0.05.The combined effect amount was statistically significant.After the sensitivity analysis,the meta-analysis results were stable.Through the funnel plot,there may be publication bias.(2)Subgroup analysis of low back pain intensity scoreIn the long-term stimulation group,2 RCTs were included,for a total of 125 patients.The results showed that I2 = 0,SMD =-0.49,95% CI [-0.84,-0.13].z=2.68,P=0.007<0.05,and the combined effect amount was statistically significant.After the sensitivity analysis,the meta-analysis results were stable.In the short-term stimulation group,3 RCTs were included,for a total of 48 patients.The results showed that I2 = 76%,SMD =-1.56,95% CI [-2.73,-0.38].z=2.60,P=0.009<0.05,the combined effect amount was statistically significant.After the sensitivity analysis,the results of the meta-analysis were unstable.(3)Regarding the low back pain function score,3 RCTs were included in the study,totaling 145 patients.Heterogeneity test results: I2 = 8%,using a fixed effect model.Combined effect amount: MD=-7.05,95% CI [-10.68,-3.43],test of combined effect amount: z=3.82,P=0.0001<0.05.The combined effect amount was statistically significant.Conclusion:1.In the relief of low back pain in patients with failed back surgery syndrome,long-term spinal cord stimulation is better than the blank control and other conventional treatment.2.In improving the lumbar function of patients with failed back surgery syndrome,the effect of spinal cord electrical stimulation is better than the blank control and other conventional treatment.3.The time of spinal cord stimulation has an effect on the efficacy of failed back surgery syndrome,the short-term spinal cord electrical stimulation may not be different from the blank control and other conventional treatment.4.Overall,spinal cord stimulation is safer,but there are still adverse reactions such as electrode displacement,pain at the pulse generator,infection or wound rupture. |
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