Methodological Quality Evaluation and Comprehensive Analysis of Clinical Practice Guidelines and Expert Consensus for Lumbar Disc Herniation

doi:10.12114/j.issn.1007-9572.2024.0051

Abstract

Abstract:

Background

Lumbar disc herniation is one of the most common causes of low back pain, and the number of cases has been increasing year by year in recent years. High-quality guidelines can standardize clinical diagnosis and treatment behaviors and improve medical quality, and screening and formulating high-quality guidelines are of great significance for standardizing the clinical practice of lumbar intervertebral disc herniation.

Objective

To systematically evaluate the methodological quality of clinical practice guidelines and expert consensus for lumbar intervertebral disc herniation, and to analyze the high-quality guidelines and consensus recommendations, in order to provide reference for the prevention and treatment of lumbar intervertebral disc herniation.

Methods

Clinical practice guidelines and expert consensus on lumbar intervertebral disc herniation were searched from the establishment of each database to October 31, 2023. At the same time, Dangdang.com and others were manually searched to obtain the guidelines for lumbar intervertebral disc herniation published in the form of monographs. After the consistency evaluation was passed by two researchers, the methodological quality of the included guidelines and consensus was evaluated using the AGREE Ⅱ tool, and the high-quality guidelines and consensus recommendations were analyzed.

Results

A total of 15 guidelines and consensus were included, and the final recommendation level of 9 guidelines was B (can be recommended after modification), and 6 guidelines and consensus were C (not recommended for the time being). Recommendations mainly include bed rest, medication, surgical treatment, etc.

Conclusion

The methodological quality of the clinical practice guidelines and expert consensus for lumbar intervertebral disc herniation needs to be further improved, and some treatment methods are controversial, and the recommendations of the guidelines need to be further improved and unified to optimize clinical practice.

Key words: Lumbar disc herniation, Lumbago, Guidelines, Expert consensus, AGREEⅡ, Methodological quality assessment

摘要：

背景

腰椎间盘突出症是腰痛最常见的原因之一，近年来发病人数逐年攀升。高质量的指南可规范临床诊疗行为，提高医疗质量，筛选和制订高质量的指南对于规范腰椎间盘突出症的临床实践具有十分重要的意义。

目的

系统分析腰椎间盘突出症诊疗指南和专家共识方法学质量，并对高质量指南和共识推荐意见进行分析，以期为腰椎间盘突出症的防治提供借鉴。

方法

计算机检索数据库、指南网和相关专业网中腰椎间盘突出症指南和专家共识，检索时间为各数据库建库至2023-10-31。同时手工检索当当网等获取以专著形式出版的腰椎间盘突出症指南。由2名研究人员通过一致性评价后，采用临床指南研究与评价系统Ⅱ（AGREE Ⅱ）对纳入的指南及共识进行方法学质量评价，并对高质量指南和共识推荐意见进行分析。

结果

共纳入15部指南及共识，最终9部评级为B级（修改后可推荐），6部为C级（暂不推荐）。推荐疗法主要包括卧床休息、药物治疗、手术治疗等。

结论

腰椎间盘突出症诊疗指南和专家共识的方法学质量有待进一步提高，部分治疗方法存在争议，指南推荐意见尚需进一步完善、统一，以优化临床实践。

关键词: 腰椎间盘突出症, 腰痛, 指南, 专家共识, 指南研究与评价工具Ⅱ, 方法学质量评价

CLC Number:

R 681.53

QIN Xiaokuan,SUN Kai,FENG Tianxiao, et al. Methodological Quality Evaluation and Comprehensive Analysis of Clinical Practice Guidelines and Expert Consensus for Lumbar Disc Herniation[J]. Chinese General Practice, 2024, 27(31): 3857-3864. DOI: 10.12114/j.issn.1007-9572.2024.0051.
秦晓宽,孙凯,冯天笑等. 腰椎间盘突出症临床实践指南和专家共识的方法学质量评价与综合分析[J]. 中国全科医学, 2024, 27(31): 3857-3864. DOI: 10.12114/j.issn.1007-9572.2024.0051.

Figures/Tables 5

References 30

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步骤	检索式
#1	（（（"Intervertebral Disc Degeneration"[Mesh]）O R "Intervertebral Disc Displacement"[Mesh]）O R（spondylochondrosis[Title/Abstract]））O R（chondrosis[Title/Abstract]）
#2	（"Lumbar Vertebrae"[Mesh]）O R "Lumbosacral Region"[Mesh]
#3	（（（"Intervertebral Disc"[Mesh]）O R（intervertebral[Title/Abstract]））O R（intradiscal[Title/Abstract]））O R（Intervertebral Disks[Title/Abstract]）
#4	#2 AND #3
#5	#1 AND #4
#6	（Lumbar disc herniation[Title/Abstract]）O R（lumbar disk hernia[Title/Abstract]）
#7	#5 OR#6
#8	guideline [Publication Type] O R guidelines [MeSH] O R practice guideline [Publication Type] O R practice guidelines [MeSH] O R consensus [MeSH]
#9	guideline* [Title/Abstract] O R consensus [Title/Abstract]
#10	#8 O R #9
#11	#7 AND #10
#12	（"1000/01/01"[Date - Publication] ："2023/10/31"[Date - Publication]）
#13	#11 AND #12

步骤	检索式
#1	（（（"Intervertebral Disc Degeneration"[Mesh]）O R "Intervertebral Disc Displacement"[Mesh]）O R（spondylochondrosis[Title/Abstract]））O R（chondrosis[Title/Abstract]）
#2	（"Lumbar Vertebrae"[Mesh]）O R "Lumbosacral Region"[Mesh]
#3	（（（"Intervertebral Disc"[Mesh]）O R（intervertebral[Title/Abstract]））O R（intradiscal[Title/Abstract]））O R（Intervertebral Disks[Title/Abstract]）
#4	#2 AND #3
#5	#1 AND #4
#6	（Lumbar disc herniation[Title/Abstract]）O R（lumbar disk hernia[Title/Abstract]）
#7	#5 OR#6
#8	guideline [Publication Type] O R guidelines [MeSH] O R practice guideline [Publication Type] O R practice guidelines [MeSH] O R consensus [MeSH]
#9	guideline* [Title/Abstract] O R consensus [Title/Abstract]
#10	#8 O R #9
#11	#7 AND #10
#12	（"1000/01/01"[Date - Publication] ："2023/10/31"[Date - Publication]）
#13	#11 AND #12

指南或共识	范围和目的	参与人员	制订的严谨性	表达清晰性	应用性	编辑独立性	指南推荐等级
腰椎间盘突出症中西医结合诊疗专家共识^[10]	61.11%	52.78%	3.13%	27.78%	2.08%	29.17%	C级
腰椎间盘突出症诊治与康复管理指南^[11]	58.33%	19.44%	37.50%	88.89%	8.33%	41.67%	B级
Japanese Orthopaedic Association（JOA）clinical practice guidelines on the management oflumbar disc herniation，third edition – secondary publication^[12]	66.67%	72.22%	62.50%	91.67%	18.75%	87.50%	B级
Korean medicine clinical practice guidelines for lumbar herniated intervertebral disc in adults：based on grading of recommendations assessment，development and evaluation（GRADE）^[13]	69.44%	44.44%	57.29%	69.44%	14.58%	79.17%	B级
老年腰椎间盘突出症诊疗指南^[14]	69.44%	25.00%	36.46%	66.67%	10.42%	29.17%	B级
中医康复临床实践指南·腰痛（腰椎间盘突出症）^[15]	58.33%	44.44%	8.33%	27.78%	4.17%	12.50%	C级
腰椎间盘突出症诊疗指南^[16]	63.89%	25.00%	36.46%	66.67%	6.25%	8.33%	B级
腰椎间盘突出症诊疗中国疼痛专家共识^[17]	25.00%	30.56%	26.04%	41.67%	2.08%	8.33%	C级
中医整脊科临床诊疗指南腰椎间盘突出症^[18]	36.11%	44.44%	8.33%	19.44%	0%	12.50%	C级
Nonsurgical treatments for patients with radicular pain from lumbosacral disc herniation^[19]	80.56%	33.33%	57.29%	69.44%	12.50%	66.67%	B级
"腰椎间盘突出症的康复治疗"中国专家共识^[20]	33.33%	25.00%	28.13%	33.33%	0%	8.33%	C级
安徽省腰椎间盘突出症分级诊疗指南（2015版）^[21]	25.00%	8.33%	0%	41.67%	6.25%	0%	C级
Treatment of lumbar disc herniation with radiculopathy. Clinical practice guidelines endorsed by the Polish Society of Spinal Surgery^[22]	58.33%	13.88%	14.58%	63.89%	6.25%	70.83%	B级
Insertion of an annular disc implantat lumbar discectomy^[23]	86.11%	16.67%	71.88%	86.11%	14.58%	41.67%	B级
An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy^[24]	80.56%	38.89%	55.21%	69.44%	6.25%	62.50%	B级
平均	58.21%	32.96%	33.54%	57.59%	7.50%	37.22%	—

指南或共识	范围和目的	参与人员	制订的严谨性	表达清晰性	应用性	编辑独立性	指南推荐等级
腰椎间盘突出症中西医结合诊疗专家共识^[10]	61.11%	52.78%	3.13%	27.78%	2.08%	29.17%	C级
腰椎间盘突出症诊治与康复管理指南^[11]	58.33%	19.44%	37.50%	88.89%	8.33%	41.67%	B级
Japanese Orthopaedic Association（JOA）clinical practice guidelines on the management oflumbar disc herniation，third edition – secondary publication^[12]	66.67%	72.22%	62.50%	91.67%	18.75%	87.50%	B级
Korean medicine clinical practice guidelines for lumbar herniated intervertebral disc in adults：based on grading of recommendations assessment，development and evaluation（GRADE）^[13]	69.44%	44.44%	57.29%	69.44%	14.58%	79.17%	B级
老年腰椎间盘突出症诊疗指南^[14]	69.44%	25.00%	36.46%	66.67%	10.42%	29.17%	B级
中医康复临床实践指南·腰痛（腰椎间盘突出症）^[15]	58.33%	44.44%	8.33%	27.78%	4.17%	12.50%	C级
腰椎间盘突出症诊疗指南^[16]	63.89%	25.00%	36.46%	66.67%	6.25%	8.33%	B级
腰椎间盘突出症诊疗中国疼痛专家共识^[17]	25.00%	30.56%	26.04%	41.67%	2.08%	8.33%	C级
中医整脊科临床诊疗指南腰椎间盘突出症^[18]	36.11%	44.44%	8.33%	19.44%	0%	12.50%	C级
Nonsurgical treatments for patients with radicular pain from lumbosacral disc herniation^[19]	80.56%	33.33%	57.29%	69.44%	12.50%	66.67%	B级
"腰椎间盘突出症的康复治疗"中国专家共识^[20]	33.33%	25.00%	28.13%	33.33%	0%	8.33%	C级
安徽省腰椎间盘突出症分级诊疗指南（2015版）^[21]	25.00%	8.33%	0%	41.67%	6.25%	0%	C级
Treatment of lumbar disc herniation with radiculopathy. Clinical practice guidelines endorsed by the Polish Society of Spinal Surgery^[22]	58.33%	13.88%	14.58%	63.89%	6.25%	70.83%	B级
Insertion of an annular disc implantat lumbar discectomy^[23]	86.11%	16.67%	71.88%	86.11%	14.58%	41.67%	B级
An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy^[24]	80.56%	38.89%	55.21%	69.44%	6.25%	62.50%	B级
平均	58.21%	32.96%	33.54%	57.59%	7.50%	37.22%	—

亚组	文献数	范围和目的	参与人员	制订严谨性	表达清晰性	应用性	编辑独立性
国内	9	58.33（25.00，69.44）	30.55±14.10	26.04（0，37.50）	45.99±23.08	4.40±3.68	16.67±13.50
国外	6	75.00（58.33，86.11）	36.57±21.26	57.29（14.58，71.88）	75.00±11.11	12.15±5.00	68.06±15.74
t（Z）值		-2.550^a	-0.663	-2.600^a	-2.841	-3.474	-6.769
P值		0.008	0.519	0.008	0.014	0.004	<0.001
指南	12	62.73±17.79	32.17±17.86	37.15±24.38	63.43±22.90	7.29（0，18.75）	41.67（0，87.50）
共识	3	39.81±18.91	36.11±14.70	19.10±13.87	34.26±6.99	2.08（0，2.08）	8.33（8.33，29.17）
t（Z）值		1.977	-0.351	1.212	2.127	-2.264^a	-1.525^a
P值		0.070	0.732	0.247	0.053	0.018	0.136
西医	11	58.84±21.97	25.00（8.33，72.22）	36.46（0，71.88）	65.40±19.66	8.33±5.43	41.67（0，87.50）
中医或中西医	4	56.25±14.23	48.61（44.44，52.78）	8.33（3.13，57.29）	36.11±22.57	5.21±6.48	20.84（12.50，79.17）
t（Z）值		0.217	-2.367^a	-1.375^a	2.464	0.941	-0.066^a
P值		0.832	0.018	0.177	0.028	0.364	0.949