Neuralgia-inducing cavitational osteonecrosis - A systematic review

Area of Science:

• Oral and Maxillofacial Surgery
• Pain Medicine
• Pathology

Background:

• Neuralgia-inducing cavitational osteonecrosis (NICO) is a poorly understood condition.
• Existing literature presents varied etiological factors and diagnostic approaches.

Purpose of the Study:

• To comprehensively review the etiological factors, diagnostic methods, and treatment strategies for NICO.
• To assess the quality of current evidence regarding NICO.

Main Methods:

• A systematic literature search was performed across major databases (Medline, Cochrane Library, PsycINFO, CINAHL, Web of Science) up to June 2020.
• NIH Quality Assessment Tools were used to evaluate the scientific quality of included studies.
• Twenty-nine observational studies were included in the full-text review.

Main Results:

• Etiology remains unclear, with hereditary coagulopathies noted as a potential risk factor in some studies.
• No definitive gold standard diagnostic method was identified.
• Surgical curettage is a common treatment, yielding variable outcomes: 66%-100% pain remission in some cases, but no relief or recurrence in up to one-third.
• All included studies were of poor quality due to high risk of bias and non-transparent reporting.

Conclusions:

• The current evidence base for NICO's etiology, diagnosis, and treatment is insufficient.
• High-quality prospective studies are required to evaluate the efficacy of invasive therapeutic procedures for NICO.