Korean Medicine Clinical Practice Guidelines for Lumbar Herniated Intervertebral Disc in Adults: Based on Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Bonhyuk Goo,Eun-Jung Kim,Yong-Hyeon Baek,Jung Won Kang,Tae-Hun Kim,Byung-Kwan Seo,Hyun-Jong Lee,Myeong Soo Lee,Dongwoo Nam,Jae-Soo Kim,Sang-Soo Nam,Yeon-Cheol Park,Min-Gi Jo

doi:10.3390/healthcare10020246

Abstract

A significant number of individuals suffer from low back pain throughout their lifetime, and the medical costs related to low back pain and disc herniation are gradually increasing in Korea. Korean medicine interventions have been used for the treatment of lumbar intervertebral disc herniation. Therefore, we aimed to update the existing Korean medicine clinical practice guidelines for lumbar intervertebral disc herniation. A review of the existing guidelines for clinical treatment and analysis of questionnaires targeting Korean medicine doctors were performed. Subsequently, key questions on the treatment method of Korean medicine used for disc herniation in actual clinical trials were derived, and drafts of recommendations were formed after literature searches using the Grading of Recommendations, Assessment, Development and Evaluation. An expert consensus was reached on the draft through the Delphi method and final recommendations were made through review by the development project team and the monitoring committee. Fifteen recommendations for seven interventions for lumbar disc herniation were derived, along with the grade of recommendation and the level of evidence. The existing Korean medicine clinical practice guidelines for lumbar intervertebral disc herniation have been updated. Continuous updates will be needed through additional research in the future.

Highlights

With the ageing of the intervertebral disc, the compression force increases, squeezing out the nucleus pulposus through the fissure and resulting in the mechanical pressure on the spinal nerve that causes low back pain (LBP) and radiating pain, known as lumbar intervertebral disc herniation (LHIVD) [1].In Korea, the overall annual incidence rate for spinal disease was a median of 16,387 per 100,000 individuals in 2016
Our clinical practice guidelines (CPGs) confirmed 15 recommendations based on the 7 types of Korean medicine (KM) treatments containing interventions, comparators, level of evidence, and grade of recommendation for the key clinical questions (Table 3)
Is acupuncture treatment helpful to improve the overall symptoms in adult patients with lumbar intervertebral disc herniation compared to usual conventional treatment (UCT)?

Summary

Introduction

With the ageing of the intervertebral disc, the compression force increases, squeezing out the nucleus pulposus through the fissure and resulting in the mechanical pressure on the spinal nerve that causes low back pain (LBP) and radiating pain, known as lumbar intervertebral disc herniation (LHIVD) [1]. In Korea, the overall annual incidence rate for spinal disease was a median of 16,387 per 100,000 individuals in 2016. The incidence rate and annual costs per patient increased by 7.6% and 14.7%, respectively, over the period from 2012 to 2016. In Korea, several Korean medicine (KM) treatments are used to treat low back pain. As a result of a survey on low back pain patients conducted by the Ministry of Health and Welfare in 2017, 83.1% of outpatients and 90.3% of inpatients answered that they thought KM was effective, indicating a high level of trust in KM treatment [4]

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