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Minimally Invasive Spinal Interventions for Back and Neck Pain in the Pediatric Population: a Systematic Review
David Jevotovsky1, Ruben Dovlatyan1, Sara Mermelstein1
1New York University Langone Medical Center, New York, NY, USA.
Insights
Spinal interventions may offer pain relief and functional improvement for pediatric patients with chronic pain. However, evidence is limited, necessitating larger studies to confirm safety and efficacy.
Area of Science:
- Pediatric pain management
- Interventional pain medicine
- Spinal procedures
Background:
- Chronic back and neck pain affect pediatric populations, often proving refractory to conservative treatments.
- Spinal interventions represent a potential therapeutic avenue for these challenging cases.
- Evaluating the efficacy and safety of these interventions in children is crucial.
Purpose of the Study:
- To systematically review the effectiveness and safety of spinal interventions for pediatric patients with chronic back and neck pain.
- To assess pain reduction and functional improvement following these procedures.
- To identify and analyze adverse events associated with spinal interventions in children.
Main Methods:
- A systematic review adhering to PRISMA 2020 guidelines was conducted.
- Searches included PubMed, Embase, Web of Science, and Cochrane Central up to August 2024.
- Included studies reported on interventional procedures for pediatric spinal pain, with outcomes assessed using subjective scales and validated instruments. Risk of bias and evidence certainty were evaluated using MASTER and GRADE scales.
Main Results:
- Eight studies involving 258 pediatric patients met the inclusion criteria.
- Common interventions included epidural steroid injections, sacroiliac joint injections, and facet injections.
- Reported pain relief and functional improvement were observed, with rare, mild, and transient adverse events. Evidence certainty was rated as 'very low' due to study limitations.
Conclusions:
- Spinal interventions show preliminary promise for pain relief and functional gains in pediatric patients unresponsive to conservative care.
- The safety profile appears comparable to that in adult populations.
- High-quality, larger, controlled studies are essential to establish definitive clinical guidelines due to current evidence limitations and heterogeneity.
Objective:
To evaluate the effectiveness and safety of spinal interventions for pediatric patients with chronic back and neck pain who failed conservative management.
Design:
Systematic review.
Methods:
Following PRISMA 2020 guidelines, a comprehensive search of PubMed, Embase, Web of Science, and Cochrane Central was performed through August 2024. Eligible studies included clinical reports of interventional procedures for pediatric spine related pain. Primary outcomes were pain reduction measured by subjective scales or validated instruments; secondary outcomes included safety and adverse events. Risk of bias and certainty of evidence were assessed using the MASTER and GRADE scales.
Results:
Of 578 identified studies, 8 met inclusion criteria, encompassing 258 pediatric patients. Interventions included epidural steroid injections (n = 227), sacroiliac joint injections (n = 13), facet injections (n = 2), ozone discolysis (n = 2), medial branch blocks (n = 1), interspinous ligament injections (n = 1), and microdiscectomy (n = 1). Across all studies, some degree of pain relief was reported, with functional improvement noted when measured. Adverse events were rare, mild, and transient, including a post-procedural headache and a transient sciatic motor block. No major long-term complications were reported. Evidence certainty was graded as 'very low' due to small sample sizes, observational designs, and heterogeneous methodologies.
Conclusions:
Preliminary evidence suggests spinal interventions may provide pain relief and functional improvement for carefully selected pediatric patients refractory to conservative measures, with a safety profile comparable to adults. However, evidence remains limited and heterogeneous. Larger, controlled studies are needed to guide clinical practice and inform future guidelines.