Irbaz Bin Riaz, MD, MM; Robert G. Badgett, MD
Disclosures: Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L15-0565.
Riaz I., Badgett R.; Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis. Ann Intern Med. 2016;164:634-635. doi: 10.7326/L15-0565
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Published: Ann Intern Med. 2016;164(9):634-635.
TO THE EDITOR:
The recent meta-analysis by Chou and colleagues (1) showed that epidural corticosteroids injections were not effective for spinal stenosis. Although the results of this systematic review, sponsored by the Agency for Healthcare Research and Quality (AHRQ), are similar to those of a previous Cochrane meta-analysis (2), juxtaposition of these reviews highlights 2 difficulties for readers attempting to synthesize a conclusion from contradictory reviews. First, regarding the inclusion of trials, 2 rigorous sponsors of meta-analyses, AHRQ and Cochrane, disagreed on the included studies. Of the 5 trials published during a period accessible to both analyses, only 2 (Cuckler et al  and Koc et al ) were included by both reviews. Second, regarding conclusions, the recent AHRQ review might have better served readers if it had reconciled its conclusion with the review by Manchikanti and colleagues (5). For example, the AHRQ review could have acknowledged Manchikanti and colleagues' review and explained that the review did not pool studies and this did not have a basis for its positive conclusion. The difference in included studies and lack of reconciliation of conclusions did not significantly influence the outcome in this example, but it certainly could happen in future reviews of more controversial topics. We propose that the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement be amended so that when prior, relevant systematic reviews exist, authors of new reviews should provide a reconciliation of conclusions of the current and prior review, along with a table reconciling the studies included. We believe that this will assist readers when they are confronted with conflicting meta-analyses.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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