Баяртай, Мөнх-Эрдэнэ

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Surgical interventions for degenerative lumbar spinal stenosis: a systematic review with network meta-analysis
(2024-10)
Chen, Lingxiao
;
Guan, Bin
;
Anderson, David B
;
Ferreira, Paulo H
;
Stanford, Ralph
BACKGROUND: Several surgical options for degenerative lumbar spinal stenosis (LSS) are available, but current guidelines do not recommend which one should be prioritized. Although previous network meta-analyses (NMAs) have been performed on this topic, they have major methodological problems and could not provide the convincing evidence and clinical practical information required. METHODS: Randomized controlled trials (RCTs) comparing at least two surgical interventions were included by searching AMED, CINAHL, EMBASE, the Cochrane Library, and MEDLINE (inception to August 2023). A frequentist random-effects NMA was performed for physical function and adverse events due to any reason. For physical function, three follow-up time points were included: short-term (< 6 months post-intervention), mid-term (≥ 6 months but < 12 months), and long-term (≥ 12 months). Laminectomy was the reference comparison intervention. RESULTS: A total of 43 RCTs involving 5017 participants were included in the systematic review and 28 RCTs encompassing 14 types of surgical interventions were included in the NMA. For improving physical function (scale 0-100), endoscopic-assisted laminotomy (mean difference: - 8.61, 95% confidence interval: - 10.52 to - 6.69; moderate-quality evidence), laminectomy combined with Coflex (- 8.41, - 13.21 to - 3.61; moderate quality evidence), and X-stop (- 6.65, - 8.60 to - 4.71; low-quality evidence) had small effects at short-term follow-up; no statistical difference was observed at mid-term follow-up (very low- to low-quality evidence); at long-term follow-up, endoscopic-assisted laminotomy (- 7.02, - 12.95 to - 1.08; very low-quality evidence) and X-stop (- 10.04, - 18.16 to - 1.93; very low-quality evidence) had a small and moderate effect, respectively. Compared with laminectomy, endoscopic-assisted laminotomy was associated with fewer adverse events due to any reason (odds ratio: 0.27, 0.09 to 0.86; low-quality evidence). CONCLUSIONS: For adults with degenerative LSS, endoscopic-assisted laminotomy may be the safest and most effective intervention in improving physical function. However, the available data were insufficient to indicate whether the effect was sustainable after 6 months. TRIAL REGISTRATION: PROSPERO (CRD42018094180).
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A systematic review on the associations between low back pain and frailty in community-dwelling older adults
(2025-09)
Bayartai, Munkh-Erdene
;
Lam, Sum Yi
;
Chan, Kei Yan
;
Lau, Wai Ying
;
Lee, Suet Ying
BACKGROUND: Frailty and low back pain (LBP) may negatively affect each other in older adults, yet no systematic review has summarized their cross-sectional, temporal, or causal associations. Exploring these associations could provide valuable insights for reducing frailty risk in older adults with LBP. This systematic review aimed to consolidate evidence on the association between frailty and LBP in older adults. METHODS: Four databases (EMBASE, CINHAL, MEDLINE, and SPORTDiscus) were systematically searched from their inception until July 31, 2024. Studies investigating the association between LBP, regardless of chronicity, or LBP-related disability and frailty in older adults were included. LBP was defined as pain occurring between the 12th ribs and inferior gluteal folds. Due to the lack of consensus on the definitions of older adults or frailty, studies were included based on the authors' definitions. Three pairs of independent reviewers screened abstracts and full texts, extracted data, assessed risk of bias, and determined the certainty of evidence. RESULTS: Out of 1,690 articles identified, six cross-sectional studies and one prospective study were included. Low-certainty evidence from four cross-sectional studies suggested that both acute and chronic LBP, with odds ratios from 1.34 to 7.50, separately showed significant correlation with frailty. Pre-frail or frail older adults reported higher chronic LBP intensity, scoring 0.5 to 0.8 points more on the numeric rating scale, and greater LBP-related disability, with scores 1.7 to 7.2 points higher on the Roland Morris Disability Questionnaire, compared to non-frail counterparts. However, there was low-certainty evidence that acute LBP intensity was unrelated to frailty. Very low-certainty evidence from the prospective study indicated that higher acute LBP intensity and disability were associated with transitioning from non-frail to prefrail or frail status. CONCLUSIONS: Our systematic review revealed that older adults with higher LBP intensity or associated disability were more likely to have prefrail or frail status, albeit with low-certainty evidence. However, the findings are limited by the small number of studies, especially prospective research. Future high-quality research should clarify the causation between LBP intensity or disability and frailty in community-dwelling older adults. Research should also explore potential mediators or moderators influencing the LBP-frailty association. These findings could help develop effective prevention and rehabilitation strategies to mitigate the impacts of LBP on frailty, or vice versa.

Б.Мөнх-Эрдэнэ

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