Scolaris Content Display Scolaris Content Display

Selection process of included articles.
Figures and Tables -
Figure 1

Selection process of included articles.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Forest plot of comparison: 1 Direct decompression ± fusion versus multimodal nonoperative care for Oswestry Disability Index, outcome: 1.1 Oswestry Disability Index.
Figures and Tables -
Figure 4

Forest plot of comparison: 1 Direct decompression ± fusion versus multimodal nonoperative care for Oswestry Disability Index, outcome: 1.1 Oswestry Disability Index.

Comparison 1 Direct Decompression ± fusion versus multimodal nonoperative care for Oswestry Disability Index, Outcome 1 Oswestry Disability Index.
Figures and Tables -
Analysis 1.1

Comparison 1 Direct Decompression ± fusion versus multimodal nonoperative care for Oswestry Disability Index, Outcome 1 Oswestry Disability Index.

Table 1. Nonoperative interventions for lumbar spinal stenosis with neurogenic claudication: a summary of GRADE assessment and outcomes

Comparisons and trials

Risk of bias

GRADE assessment and outcomes/measures (walking ability, pain, function, and quality of life) at each follow‐up point

Consistency

Directness

Precision

Selective

reporting

Immediate

Short‐term

Intermediate

Long‐term

Quality of the evidence

Calcitonin

Calcitonin injection versus placebo injection

Eskola 1992

High

High

No

No

Yes

Yes

No

No

Yes

Yes

 

= TWT

= VAS

= TWT

= VAS

= TWT

= VAS

+000

+000

Porter 1983

High

No

Yes

No

Yes

 

? distance walked

? distance walked

 

+000

Porter 1988

High

High

No

No

Yes

Yes

No

No

Yes

Yes

 

= distance walked

= VAS

 

 

+000

+000

Calcitonin nasal spray versus placebo nasal spray

Podichetty 2004

High

High

High

High

No

No

No

No

Yes
Yes

Yes

Yes

No

No

No

No

Yes

 

= distance walked

= time walked

= SF‐36

= VAS

 

 

+000

+000

+000

+000

Tafazal 2007

High

High

High

High

High

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

 

 

= Shuttle walk

= VAS leg

= VAS back

= ODI

= global

 

 

+000

+000

+000

+000

+000

Calcitonin nasal spray plus physical therapy versus paracetamol plus physical therapy

Sahin 2009

High

High

High

No

No

No

Yes

Yes

Yes

No

No

No

 

 

= distance walked

= VAS

= RMDI

 

 

+000

+000

+000

Oral medication

Oral prostaglandin versus etodolac (NSAID)

Matsudaira 2009

 

Low

Low

Low

Low

Low

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

 Yes

 

> distance walked

? SF‐36

= LBP

> Leg pain

> global

 

 

++00

+000

++00

++00

++00

Methylocobalamin (vitamin B12) plus conservative care versus conservative care

Waikakul 2000

High

No

Yes

No

Yes

> distance walked

> distance walked

+000

Gabapentin versus placebo

Yaski 2007

 

High

High

High

No

No

No

Yes

Yes

Yes

No

No

No

 

 

 

> distance walked

= VAS (1‐2 months)

> VAS (3 months)

> distance walked

> VAS

+000

+000

+000

Physical therapy

Exercise plus ultrasound versus exercise plus sham ultrasound

Goren 2010

Low

Low

Low

Low

No

No

No

No

Yes

Yes

Yes

Yes

No

No

No

No

 

 

= TWT

= VAS back

= VAS leg

= ODI

 

 

++00

++00

++00

++00

Exercise plus ultrasound versus no treatment

Goren 2010

Low

Low

Low

Low

No

No

No

No

Yes

Yes

Yes

Yes

No

No

No

No

 

 

= TWT

= VAS back

> VAS leg

> ODI

 

 

++00

++00

++00

++00

Exercise plus sham ultrasound versus no treatment

Goren 2010

Low

Low

Low

Low

No

No

No

No

Yes

Yes

Yes

Yes

No

No

No

No

 

 

= TWT

= VAS back

> VAS leg

> ODI

 

 

++00

++00

++00

++00

Inpatient physical therapy versus home exercise program plus oral diclofenac

Koc 2009

High

High

High

High

No

No

No

No

Yes

Yes

Yes

Yes

No

No

No

No

Yes

 

= TWT

> VAS

> RMDI

> NHP

= TWT

= VAS

= RMDI

= NHP

 

+000

+000

+000

+000

Unweighted treadmill walking plus exercise versus cycling plus exercise

Pua 2007

Low

Low

Low

Low

Low

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

 

 

= distance walked

= ODI

= RMDI

= VAS

= global

 

 

++00

++00

++00

++00

++00

Manual therapy, exercise and unweighted treadmill versus flexion exercise, walking and sham ultrasound

Whitman 2006

High

High

High

High

No

No

No

No

Yes

Yes

Yes

Yes

No

No

No

No

 

 

= TWT

> global

= ODI

= NPRS

 

= global

+000

+000

+000

+000

Epidural injection

Translaminar epidural steroid injections versus placebo injections

Cuckler 1985

High

No

Yes

No

= global

=global

+000

Translaminar epidural steroids plus epidural block versus placebo injections

Fukusaki 1988

High

No

Yes

No

 

> distance walked

= distance walked

 

 

+000

Translaminar epidural steroids plus epidural block versus epidural block injections

Fukusaki 1988

High

No

Yes

No

 

= distance walked

= distance walked

 

 

+000

Translaminar epidural block versus placebo

Fukusaki 1988

High

No

Yes

No

 

> distance walked

= distance walked

 

 

+000

Intralaminar epidural steroid plus epidural block versus home exercise program plus oral diclofenac

Koc 2009

High

High

High

High

No

No

No

No

Yes

Yes

Yes

Yes

No

No

No

No

Yes

Yes

Yes

Yes

 

= TWT

> VAS

> RMDI

> NHP

= TWT

= VAS

= RMDI

= HNP

 

+000

+000

+000

+000

Intralaminar epidural steroid plus epidural block versus inpatient physical therapy

Koc 2009

High

High

High

High

No

No

No

No

Yes

Yes

Yes

Yes

No

No

No

No

Yes

Yes

Yes

Yes

 

= TWT

> VAS

> RMDI

> NHP

= TWT

= VAS

= RMDI

= HNP

 

+000

+000

+000

+000

Caudal epidural steroids versus placebo injections

Zahaar 1991

High

No

Yes

No

 

= global

 

 

= global

+000

Multimodal nonoperative treatment

Indirect decompression using interspinous spacer (X‐Stop) versus multimodal nonoperative care for degenerative spondylolisthesis

Zucherman 2004, Anderson

2006

High

No

Yes

No

SR (short &

intermediate)

 

> ZCQ

> ZCQ

> ZCQ

+000

Indirect decompression using interspinous spacer (X_Stop) versus multimodal nonoperative care

Zucherman 2004, 2005, Hsu 2006

High

No

No

Yes

Yes

No

No

SR

SR

 

> ZCQ

> SF‐36

> ZCQ

> SF‐36

> ZCQ

> SF‐36

+000

+000

Direct decompression ± fusion versus multimodal nonoperative care for degenerative spondylolisthesis

Weinstein 2007

High

High

High

High

High

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

 

 

= SF‐36

= ODI

= LBPBS

= LPBI

= SBS

= SF‐36

= ODI

= LBPBS

= LPBI

= SBS

= SF‐36

= ODI

= LBPBS

= LPBI

= SBS

+000

+000

+000

+000

+000

Direct decompression ± fusion versus multimodal nonoperative care

Amundsen 2000

High

High

No

No

Yes

Yes

No

No

 

 

?* pain severity

?* global

?* pain severity

? global

+000

+000

Malmivaara 2007

Low

Low

Low

Low

Low

Low

No

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

No

 

 

= TWT

= SW

> VAS leg walk

> VAS leg

> VAS  LB

ODI (see Figure 4)

= TWT

= SW

> VAS leg walk

> VAS leg

> VAS  LB

ODI (see Figure 4)

++00

++00

++00

++00

++00

+000

Weinstein 2008

High

High

High

High

High

High

No

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

No

 

 

= SF‐36 BP

= SF‐36 PF

= LBPBS

= LPBI

= SBS

= ODI

= SF‐36 BP

= SF‐36 PF

= LBPBS

= LPBI

= SBS

ODI (see Figure 4)

> SF‐36 BP**

= SF‐36  PF

= LBPBS

= LPBI

= SBS

ODI (Figure 4)

+000

+000

+000

+000

+000

+000

Follow‐up points: Immediate = up to 1 week, short‐term = >1 week ‐ 3 months, intermediate = 3 months ‐ 1 year, long‐term = > 1 year

> statistically significant favouring intervention (first comparison), < statistically significant favouring control (second comparison), = no statistically significant difference between intervention and control groups

TWT = Treadmill Walking Test, VAS = Visual Analog Scale for Pain Intensity, RMDI = Roland‐Morris Back Disability Index, NHP = Nottingham Health Profile, Global = Patient Perceived Improvement, SR = Selective Reporting, ODI = Oswestry Back Disability Index, ? = insufficient data, LBP = Low back Pain Severity Scale, Leg pain = Leg Pain Severity Scale, ? SF‐36 = No data on overall score, improvement in some subscales, NPRS = Numeric Pain Rating Scale, SF‐36 BP = SF‐36 Bodily Pain Subscale, SF‐36‐ PF = SF‐36 Physical Function Subscale, LBPBS ‐ Low Back Pain Bothersome Scale, LPBI = Leg Pain Bothersome Index, SBS ‐ Stenosis Bothersome Scale, SW = Subjective Walking, VAS leg = Visual Analog Scale for Leg Pain, VAS LB = Visual Analog Scale for Low Back Pain, VAS leg walking = Visual Analog Scale for Leg pain while walking, ?* = no between group statistical comparisons, ** = SF‐36 BP significantly better at 2 years but not 4 years.

GRADE evidence: +000 = Very low quality evidence, ++00 = Low quality evidence, +++0 = Moderate quality evidence, ++++ = High quality evidence

Figures and Tables -
Table 1. Nonoperative interventions for lumbar spinal stenosis with neurogenic claudication: a summary of GRADE assessment and outcomes
Comparison 1. Direct Decompression ± fusion versus multimodal nonoperative care for Oswestry Disability Index

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Oswestry Disability Index Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 6 Months

2

349

Mean Difference (IV, Random, 95% CI)

‐3.66 [‐10.12, 2.80]

1.2 12 Months

2

340

Mean Difference (IV, Random, 95% CI)

‐6.17 [‐15.02, 2.67]

1.3 24 Months

2

315

Mean Difference (IV, Random, 95% CI)

‐4.43 [‐7.91, ‐0.96]

Figures and Tables -
Comparison 1. Direct Decompression ± fusion versus multimodal nonoperative care for Oswestry Disability Index