Comparative Efficacy Of Chinese Herbal For Treating Of Residual Symptoms After Percutaneous Endoscopic Lumbar Discectomy: A Network Meta-Analysis

Objective:To evaluate the efficacy and safety of oral traditional Chinese medicine compound in the treatment of residual symptoms after Percutaneous endoscopic lumbar discectomy(PELD).To compare the effects of different oral traditional Chinese medicine compounds on patients with residual symptoms after PELD,and to select the most effective traditional Chinese medicine compound,in order to provide evidence-based medical evidence for patients and clinicians to better understand the advantages of oral traditional Chinese medicine.Methods:The databases of CNKI,Wanfang,VIP,CBM,Pub Med,EMBASE,Cochrane Library and Web of Science were searched for randomized controlled trials(RCTs)of oral Chinese herbal compound in the treatment of patients with residual symptoms after PELD controlled trial,RCT),and the search time was from the establishment of the database to October 2022.Two researchers independently screened the literature,extracted the data and assessed the risk of bias of the included studies.Review Manager 5.3 software was used for meta-analysis,and Stata 16.0 software was used for network meta-analysis.Results:A total of 42 RCTs were included in this study,including 3306 patients with residual symptoms after PELD and 9 oral Chinese herbal formulas(Buyang-Huanwu decoction,DuhuoJisheng Decoction,Shen Tong-Zhuyu decoction,Taohong-Siwu decoction,Bushen-Huoxue decoction,Zhiqiao-Gancao decoction,self-drafted Huoxue-Buganshen Decoction,self-drafted Huoxue-Lishui Decoction,and self-drafted Buqi-Huoxue Decoction).The quality of the included literature was assessed according to the risk of bias assessment tool in the Cochrane handbook.In terms of random sequence generation,2 RCTs were low-risk,34 were unclear,and 6 were high-risk.In terms of allocation concealment,42 RCTs were unclear;In terms of blinding of Participants and researchers,1 RCT was low-risk and 41 were unclear.In terms of the blinding method of outcome assessment,1 RCT was low-risk and 41 were unclear.In terms of the completeness of the outcome data,40 RCTs were low-risk and 2 were unclear.In terms of selective reporting,9 RCTs were low-risk and 33 were unclear.In terms of other sources of bias,1 RCT was low-risk,38 were unclear,and 3 were high-risk.The quality of the included studies was evaluated according to the modified Jadad scale.Among them,low quality(1-3points)accounted for 17%(7/42),and high quality(4-7 points)accounted for 83%(35/42).Meta-analysis results showed that:(1)Visual analogue scale(VAS)score: Oral traditional Chinese medicine compound compared with conventional therapy [mean difference(MD)=-0.68,95% confidence interval(CI):-0.77 to-0.59,P< 0.00001],indicating that compared with conventional therapy,oral Chinese herbal compound can significantly reduce the VAS score of patients with residual symptoms after PELD.(2)Oswestry disability index(ODI): Compared with conventional therapy,oral Chinese medicine compound could significantly reduce ODI score in patients with residual symptoms after PELD [MD=-5.05,95%CI:-6.02 to-4.09,P< 0.00001].(3)Effective rate: compared with conventional therapy,oral Chinese medicine compound could significantly improve the effective rate of patients with residual symptoms after PELD [relative risk(RR)= 1.05,95%CI: 1.02 to 1.08,P= 0.0003].(4)Adverse reactions: compared with conventional therapy,oral Chinese medicine compound had more adverse reactions in patients with residual symptoms after PELD [RR= 1.86,95%CI: 0.78 to 4.39,P= 0.16].The results of network meta-analysis showed that:(1)VAS score: Compared with other treatments,Bushen-Huoxue decoction [area under the cumulative ranking curves(SUCRA):99.9%] and Duhuo-Jisheng decoction(SUCRA: 88.8%)was the best way to reduce VAS score.(2)ODI score: compared with other treatments,Duhuo-Jisheng decoction(SUCRA: 95.8%)and self-drafted Huoxue-Lishui decoction(SUCRA: 93.0%)were the best ways to reduce ODI score.(3)Effective rate: compared with other treatments,Duhuo-Jisheng decoction(SUCRA:93.2%)and self-drafted Huoxue-Buganshen decoction(SUCRA: 87.3%)were the best ways to improve the effective rate.(4)Adverse reactions: compared with other therapies,usual care(SUCRA: 84.1%)and self-drafted Huoxue-Buganshen decoction(SUCRA: 53.9%)is the way to produce the least adverse reactions.Conclusions:This study showed that oral Chinese herbal compound in the treatment of residual symptoms after PELD can reduce VAS score and ODI score to a certain extent,and improve the effective rate of treatment.Although there is no significant advantage in reducing adverse reactions,all adverse reactions were spontaneously relieved,and no serious adverse reactions were observed,which has certain efficacy and safety.Duhuo-jisheng decoction may be the most ideal oral traditional Chinese medicine compound for the treatment of residual symptoms after PELD,and it is worthy of clinical application.At the same time,Bushen-Huoxue decoction and self-drafted Huoxue-Buganshen decoction are also one of the recommended traditional Chinese medicine formulas.