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Letters to the Editor
Comments on the Article Entitled “Clinical
Effectiveness of Posterior Annular Targeted
Ablative Decompression as an Alleviative
Intervention for Lumbosacral Discogenic Pain:
Systematic Review and Meta-analysis”
With interest, I read the recently published article
entitled “Clinical Effectiveness of Posterior Annular
Targeted Ablative Decompression as an Alleviative In-
tervention for Lumbosacral Discogenic Pain: System-
atic Review and Meta-analysis” by Lee et al (1). The
researchers conducted a systematic review and meta-
analysis of the efficacy of posterior annular targeted
decompression for treating lumbosacral discogenic
pain in terms of pain control or functional improve-
ment. They reviewed 12 studies and included 8 in the
meta-analysis. I believe this study is meaningful, but I
have an issue.
The authors stated that they included previous
studies of human patients (≥ 18 years) with axial back
pain supported by magnetic resonance imaging (MRI)
findings of lumbosacral internal disc derangement,
bulging, or a high-intensity zone. The authors wrote
that they excluded studies that included patients with
prominent disc herniation in MRI. However, 2 of the 12
included studies should not have been included (2,3).
The An et al (2) study included rats, not humans. Also,
the Kim et al (3) study included patients who were di-
agnosed with lumbar intervertebral disc herniation
confirmed on MRI, who had back pain, lower-extremity
radicular pain, or both. Therefore, the targeted dis-
order in the Kim et al. study was not discogenic back
pain; rather, it was pain from lumbar intervertebral
disc herniation, which aligns with the exclusion crite-
ria of the Lee et al (1) study. Therefore, the remaining
10 studies should have been included in the Lee et al.
review, while only 6 should have been included for the
meta-analysis.
In conducting a systematic review or meta-analysis,
it is essential to rigorously adhere to the study inclu-
sion and exclusion criteria. The inclusion of studies
that should not have been included can compromise a
study’s credibility.
Min Cheol Chang, MD
Department of Physical Medicine & Rehabilitation,
College of Medicine, Yeungnam University, Nam-
gu, Daegu, Republic of Korea
E-mail: wheel633@ynu.ac.kr
Pain Physician 2023; 26:E859-E862 • ISSN 2150-1149
To The ediTor:
1. Lee JH, Lee YJ, Park HS, Lee JH. Clini-
cal effectiveness of posterior annular tar-
geted ablative decompression as an alle-
viative intervention for lumbosacral dis-
cogenic pain: Systematic review and me-
ta-analysis. Pain Physician 2023; 26:E437-
E447
2. An G, Guan Y, Wan R, et al. Pathomech-
anism of lower-level discogenic groin
pain and clinical outcomes of percutane-
ous endoscopic discectomy for the treat-
ment of discogenic groin pain. Pain Phy-
sician 2021; 24:E289-E297.
3. Kim JY, Lee KS, Jung SM, Kim YH. Prog-
nostic factors for successful percutane-
ous disc decompression using the nav-
igable device L’DISQ™ in patients with
lumbar discogenic pain. Pain Physician
2022; 25:E157-E164.
references