Korean Medicine for Thoracolumbar Compression Fracture in Korean Literature: a Systematic Review

Article information

Acupunct. 2015;32(4):147-156
1Department of Acupuncture & Moxibustion, Pusan National University Korean Medicine Hospital
2Department of Clinical Medicine, School of Korean Medicine, Pusan National University
*Corresponding author: Department of Clinical Medicine School of Korean Medicine, Pusan National University, 20, Geumo-ro, Mulgeum-eup, Yangsan-city, Gyeongsangnam-do, 626-770, Republic of Korea, Tel: +82-55-360-5971, E-mail: pdchrist@gmail.com

This work was supported by clinical research grant from Pusan National University Hospital in 2014

Received 2015 November 18; Revised 2015 December 10; Accepted 2015 December 14.

Abstract

Objectives:

This study aims to evaluate the effectiveness and safety of Korean medicine for a thoracolumbar compression fracture

Methods:

We searched six Korean databases (DBPIA Korean Studies Information Service System Oriental Medicine Advanced Searching Integrated System National Digital Science Library Research Information Sharing Service KoreaMed) (up to June 2015) and the Journal of Korean Acupuncture and Moxibustion Society Unpublished studies were also searched Clinical research other than case reports involving less than 10 patients were eligible The effectiveness and safety of Korean Medicine was analyzed The ‘Risk of Bias’ was assessed using the ‘Risk of Bias’ assessment tool for non-randomized studies as well as the Cochrane Collaboration’s ‘Risk of Bias’ tool

Results:

We found 12 before-after studies (374 patients) There was no randomized trial All studies combined at least three different types of Korean medicine treatments The period of treatment varied between less a week and 154 days All the included studies reported improvements in pain functional disability related to lower back pain global assessment and benefits in the compression ratio of a fractured vertebrae and skin temperature measured by digital infrared thermal imaging in comparison with the baseline However all studies had a high risk of bias and three studies reported mild adverse events

Conclusions:

There is no randomized trial for the role of Korean medicine for patients with a thoracolumbar compression fracture The effectiveness and safety of Korean medicine for this population remains unclear Findings in this review are seriously biased due to observational design and a high risk of bias included in the studies Future high-quality randomized trials are warranted

Fig. 1

Flowchart of Study Selection Process

KISS*: Korean Studies Information Service System

RISS: Research Information Sharing Service

OASIS: Oriental Medicine Advanced Searching Integrated System

NDSL§: National Digital Science Library

One Journal: The Journal of Korean Acupuncture & Moxibustion Society

Fig. 2

Summary of Risk of Bias

Characteristics of Included Studies

References

1. Society KSN. The Textbook of Spine. ver 2.0 2013. p. 523–48.
2. Denis F. The three column spine and its significanceinthe classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 1983;8(8):817–31.
3. Melton LJ 3rd, Thamer M, Ray NF, et al. Fractures attributable to osteoporosis: report from the National Osteoporosis Foundation. J Bone Miner Res 1997;12(1):16–23.
4. Genant HK, Cooper C, Poor G, et al. Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis. Osteoporos Int 1999;10(4):259–64.
5. Oudshoorn C, Hartholt KA, Zillikens MC, et al. Emergency department visits due to vertebral fractures in the Netherlands, 1986–2008: steep increase in the oldest old, strong association with falls. Injury 2012;43(4):458–61.
6. Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ 3rd. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 1992;7(2):221–7.
7. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006;17(12):1726–33.
8. David S, Kuhn C, Ekkernkamp A. Fracture of the proximal humerus in children and adolescents. The most overtreated fracture. Chirurg 2006;77(9):827–34.
9. Silverman SL. The clinical consequences of vertebral compression fracture. Bone 1992;13(Suppl 2):S27–31.
10. Hasserius R, Karlsson MK, Nilsson BE, Redlund-Johnell I, Johnell O, European Vertebral Osteoporosis S. Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int 2003;14(1):61–8.
11. Hasserius R, Karlsson MK, Jonsson B, Redlund-Johnell I, Johnell O. Long-term morbidity and mortality after a clinically diagnosed vertebral fracture in the elderly–a 12- and 22-year follow-up of 257 patients. Calcif Tissue Int 2005;76(4):235–42.
12. Agulnek AN, O’Leary KJ, Edwards BJ. Acute vertebral fracture. J Hosp Med 2009;4(7):E20–4.
13. Lee JY, Vaccaro AR, Lim MR, et al. Thoracolumbar injury classification and severity score: a new paradigm for the treatment of thoracolumbar spine trauma. J Orthop Sci 2005;10(6):671–5.
14. Association TKO. Orthopeadics 6th edth ed. Seoul: Choishin Medical; 2006. p. 957–88.
15. Savage JW, Schroeder GD, Anderson PA. Vertebroplasty and Kyphoplasty for the Treatment of Osteoporotic Vertebral Compression Fractures. J Am Acad Orthop Surg 2014;22(10):653–64.
16. Deramond H, Depriester C, Galibert P, Le Gars D. Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am 1998;36(3):533–46.
17. Buchbinder R, Golmohammadi K, Johnston RV, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Syst Rev 2015;4:CD006349.
18. Abudou M, Chen X, Kong X, Wu T. Surgical versus non-surgical treatment for thoracolumbar burst fractures without neurological deficit. Cochrane Database Syst Rev 2013;6:CD005079.
19. JI SY. Bibliographic study on method of treating the diseases inside the body applied to fracture. The Journal of Korean Medicine Ophthalmology, Otolaryngology & Dermatology 1995;8(1):113–29.
20. Higgins JPT GS. Cochrane handbook for systematic reviews of interventions. version 5.0.2 The Cochrane Collaboration; 2009. p. 187–241.
21. Kim SY, Park JE, Lee YJ, et al. Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. J Clin Epidemiol 2013;66(4):408–14.
22. Higgins J GS. Analysing and presenting results. Cochrane handbook for systematic reviews of interventions 4.2.6 Chichester, UK: John Wiley & Sons Inc; 2008. p. 79–165.
23. Lee GM, Moon SJ, Lee BC. Clinical evaluation of Oriental Medicine treatment of Stable Compression Fracture by D.I.T.I. The Acupuncture 1997;1(1):28–37.
24. Jin ES, Koh DH, Kim HN. The Clinical Study of 35 Admission Patients to Oriental Medical Hospital due to Thoraco-Lumbar Compression Fracture. Korean Society of Chuna manual Medicine for Spine and Nerves 2008;3(2):19–27.
25. Lee GM, Seong NG, Chae WS. Clinical Study of Stable Thoracolumbar Vertebral Fractures. The Acupuncture 1993;10(1):339–52.
26. Joh BJ, Koh PS, Yi WI, Baek YH, Nam TH, Park DS. Clinical study on 16 conservatively treated acute compression fracture patients with focus on compression ratio. The Acupuncture 2009;26(4):1–9.
27. Lee JG, Lee BR. The clinical study on 32 cases of patient with Thoracolumbar Compression Fracture. The Acupuncture 1998;15(2):427–36.
28. Oh H, Kim ID, Byun JY, Ahn SG. The Clinical Study on 40 cases of Patient with Thoracolumbar Fracture. The Acupuncture 2001;18(2):227–36.
29. Lim JE, Kim KH, Hwang HS. The clinical study on 44 cases of patient with Thoracolumbar Compression Fracture. The Acupuncture 2000;17(2):41–51.
30. Lee SN, Hong SY, Byun IJ. The Clinical Study on Bee Venom Acupuncture Treatment of Patient with Thoracolumbar Compression Fracture. The Acupuncture 2002;19(6):35–48.
31. Song WS, Hwang JY, Shin YI, Lee BR. The Clinical Study on Hua-Tua-Jia-Ji-Xue Acupuncture Treatment of Patient with Thoracolumbar Compression Fracture. The Acupuncture 2001;18(4):55–67.
32. Yang GR, Sohn HS. Effect of Bee Venom Acupuncture complex Therapy of Thoracolumbar Compressiono Fracture. The Acupuncture 2008;25(3):29–39.
33. Jung KH, Cha JH, Hwang HS. Effect of Oriental Medicine Treatment on Inpatient with Thoracolumbar Compression Fracture. The Acupuncture 2009;26(1):81–90.
34. Han JS, Heo DS, Keum DH. Prognostic Factors of Stable Thoracolumbar Spine Fracture. JORM 2001;11(4):49–58.
35. Kim SY, Choi MY, Shin SS, et al. Handbook for Clinical Practice Guideline Developer: Version 1.0. NECA 2015;:383–8.
36. Holdsworth F. Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am 1970;52(8):1534–51.
37. Hrobjartsson A, Thomsen AS, Emanuelsson F, et al. Observer biasin randomised clinical trials with binary outcomes: systematic review of trials with both blinded and non-blinded outcome assessors. Bmj 2012;344:e1119.
38. White A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med 2004;22(3):122–33.
39. Park JY, Kim SY, Chae YB, et al. Systematic Review of Adverse Events Related to Acupuncture and Moxivbustion in Korea. J Korean Oriental Med 2010;31(2):78–90.
40. Chang V, Holly LT. Bracing for thoracolumbar fractures. Neurosurg Focus 2014;37(1):E3.
41. Savage JW, Schroeder GD, Anderson PA. Vertebroplasty and Kyphoplasty for the Treatment of Osteoporotic Vertebral Compression Fractures. Journal of the American Academy of Orthopaedic Surgeons 2014;22(10):653–4.
42. Koester MC, Spindler KP. Pharmacologic agents in fracture healing. Clin Sports Med 2006;25(1):63–73. :viii.
43. Lee HJ, Seo JC, Park SH, et al. Acupuncture in patients with a vertebral compression fracture: a protocol for a randomized, controlled, pilot clinical trial. J Pharmacopuncture 2015;18(1):79–85.
44. Han JS, Terenius L. Neurochemical basis of acupuncture analgesia. Annu Rev Pharmacol Toxicol 1982;22:193–220.
45. Mak JC. Acupuncture in osteoporosis: more evidence is needed. Acupunct Med 2015;33(6):440–1.
46. He J, Yang L, Qing Y, He C. Effects of electroacupuncture on bone mineral density, oestradiol level and osteoprotegerin ligand expression in ovariectomised rabbits. Acupunct Med 2014;32(1):37–42.
47. MacPherson H, White A, Cummings M, Jobst K, Rose K, Niemtzow R. Standards for reporting interventions in controlled trials of acupuncture: the STRICTA recommendations. Complement Ther Med 2001;9(4):246–9.
48. McGuire R. AAOS Clinical Practice Guideline: the Treatment of Symptomatic Osteoporotic Spinal Compression Fractures. J Am Acad Orthop Surg 2011;19(3):183–4.
49. Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 2010;8:18.

Article information Continued

Fig. 1

Flowchart of Study Selection Process

KISS*: Korean Studies Information Service System

RISS: Research Information Sharing Service

OASIS: Oriental Medicine Advanced Searching Integrated System

NDSL§: National Digital Science Library

One Journal: The Journal of Korean Acupuncture & Moxibustion Society

Fig. 2

Summary of Risk of Bias

Table 1

Characteristics of Included Studies

Author (year) Number of patient Intervention Outcome
Acupuncture Herb Cupping Moxibustion Medication Others Measurement Adverse events
Jung (2009)33) 48 · · PT*, BR Global Assessment NR
Joh (2009)29) 16 Brace, BR 1. Primary outcome: Compression Ratio
2. Secondary outcome: Visual Analogue Scale
NR
Jin (2008)24) 35 · · · PT Numerical Rating Scale No occurrence
Yang (2008)32) 28 · PT, BR Visual Analogue Scale Oswestry Disability Index NR
Lee (2002)30) 39 · PT, BR Global Assessment No occurrence
Song (2001)31) 50 · · PT, BR Brace Global Assessment NR
Oh (2001)28) 40 · · PT, BR Global Assessment NR
Han (2001)34) 31 · PT, Brace, Chuna Global Assessment, Compression Ratio Reported
Lim (2000)29) 44 · PT, BR Global Assessment NR
Lee (1998)27) 32 · · PT, BR Global Assessment NR
Lee (1997)23) 40 · · PT, Brace DITI§ Global Assessment NR
Lee (1993)25) 20 · · · PT, Brace Global Assessment NR

PT*: physical therapy, This includes hot pack, exercise, transcutaneous electrical nerve stimulation (TENS), interferential current therapy (OCT), ultra sound (US) and infra red (IR).

BR: bed rest.

NR: not reported.

DITI§: digital infrared thermal imaging.

Reported: This includes constipation (n=19), indigestion/anorexia (n=16), upper respiratory infection (n=9), leg pain/paresthesia/weakness (n=7), urination disorder (n=7), headache/dizziness (n=6), general weakness (n=5), chest discomfort (n=5), sleep disorder (n=4), urinary tract infection (n=2).