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Cirugía para la espondilosis lumbar degenerativa

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Referencias

Amundsen 2000 {published data only}

Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleas F. Lumbar spinal stenosis; conservative or surgical management? A prospective 10‐year study. Spine 2000;11:1424‐36.

Barendse 2001 {published data only}

Barendse GAM, van den Berg SGM, Kessels AHF, Weber WEJ, van Kleef M. Randomized controlled trial of percutaneous intradiscal radiofrequency thermocoagulation for chronic discogenic back pain. Spine 2001;26:287‐92.

Bridwell 1993 {published data only}

Bridwell KH, Sedgewick TA, O'Brien MF, Lenke LG, Baldus C. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 1993;6(6):461‐72.

Brox 2003 {unpublished data only}

Brox JI, Sorensen R, Friis A, Indahl A, Keller A, Reikeras O, et al. Randomised clinical trial of lumbar instrumented fusion and cognitive intervention and exercises of patients with chronic low back pain and disc degeneration. Proceedings of the International Society for Study of the Lumbar Spine. 2003.
Brox JI, Sorensen R, Friis A, Nygaard O, Indahl A, Keller A, et al. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine 2003;28(17):1913‐21.

Brox 2004 {published data only}

Keller A, Brox JI, Gunderson R, Holm I, Friis A, Reikeras O. Trunk muscle strength, cross‐sectional area and density in patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises. Spine 2004;29(1):3‐8.

Carragee 1997 {published data only}

Carragee EJ. Single‐level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults. A prospective, randomised study. J Bone Joint Surg 1997;79‐A:1175‐80.

Christensen 2002 {published data only}

Bunger C, Eiskjaer S, Hansen ES, Thomsen K, Hoy K, Helmig P, et al. Controversies in lumbar spine fusion ‐ the role of pedicle screw fixation and 360º fusion ‐ randomized prospective studies. Acta Orthop Scand. 1998; Vol. 69:26.
Bunger C, Hansen ES, Hoy K, Neumann P, Niedermann B, Lindblad BE, et al. Lumbar spine fusion. A randomized prospective study of circumferential fusion with the ALIF Brantigan cage versus posterolateral fusion with titanium CDI. Proceedings of the British Scoliosis Society. 2001.
Christensen FB, Hansen ES, Eiskjaer SP, Hoy K, Helmig P, Neumann P, et al. Circumferential lumbar spinal fusion with ALIF Brantigan cage versus posterolateral fusion with titanium CD‐Horizon: a prospective, randomized, clinical study of 146 patients. Spine 2002;27(23):2674‐83.

Delamarter 2003 {published data only}

Bae H, Pradhan B, Kanim L, Lam L, Kamrava E, Delamarter R. Clinical results after lumbar total disc replacement: A 2 to 3 year report from the United States clinical trial for the ProDisc‐II prosthesis. Proceedings of the International Society for the Study of the Lumbar Spine. 2005:27.
Delamarter RB, Fribourg DM, Kanim LE, Bae H. ProDisc artificial total lumbar disc replacement: introduction and early results from the United States clinical trial. Spine 2003;28(20S):S167‐75.

Fischgrund 1997 {published data only}

Fischgrund J, McKay M, Herkowitz H, Brower R, Montgomery D, Kurz L. Degenerative lumbar spondylolisthesis with spinal stenosis: A prospective, randomized study, comparing decompression and fusion with and without posterior pedicular instrumentation. Orth Trans 1997;21:158.
Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis: A prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 1997;22:2807‐12.

France 1999 {published data only}

France JC, Yaszemski MJ, Lauerman WC, Cain JE, Glover JM, Lawson KJ, et al. A randomized prospective study of posterolateral lumbar fusion: Outcomes with and without pedicle screw instrumentation. Orthop Trans. 1997; Vol. 21:157.
France JC, Yaszemski MJ, Lauerman WC, Cain JE, Glover JM, Lawson KJ, et al. A randomized prospective study of posterolateral lumbar fusion: Outcomes with and without pedicle screw instrumentation. Spine 1999;24:553‐60.

Freeman 2003 {published data only}

Freeman BJC, Fraser RD, Cain CMJ, Hall DJ. A randomised double‐blind controlled efficacy study: intradiscal electrothermal therapy (IDET) versus placebo. J Bone Joint Surg. 2003; Vol. 85‐B, issue Supp III:280.
Freeman BJC, Fraser RD, Cain CMJ, Hall DJ. A randomized double‐blind controlled efficacy study: Intradiscal electrothermal therapy (IDET) versus placebo. Proceedings of the International Society for Study of the Lumbar Spine. 2003:Abstract 11.

Fritzell 2001 {published data only}

Fritzell P, Hagg O, Jonsson D, Nordwall A, the Swedish Lumbar Spine Study Group. Cost‐effectiveness of lumbar fusion and nonsurgical treatment for chronic low back pain in the Swedish Lumbar Spine Study: A multicenter, randomized, controlled trial from the Swedish Lumbar Spine Study Group. Spine 2004;29(4):421‐34.
Fritzell P, Hagg O, Nordwall A, the Swedish Lumbar Spine Group. Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group. Eur Spine J 2003;12(2):178‐89.
Fritzell P, Hagg O, Wessberg P, Nordwall A. 2001 Volvo award winner in clinical studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: A multicentre randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine 2001;26:2521‐34.

Goodwin 1999 {published data only}

Goodwin CB, Brighton CT, Guyer RD, Johnson JR, Light KI, Yuan HA. A double‐blind study of capacitively coupled electrical stimulation as an adjunct to lumbar spinal fusions. Spine 1999;24(13):1349‐57.

Grob 1995 {published data only}

Grob D, Humke T, Dvorak J. Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg Am 1995;77(7):1036‐41.

Herkowitz 1991 {published data only}

Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am 1991;73‐A(6):802‐8.

Jenis 2000 {published data only}

Jenis LG, An HS, Stein R, Young B. Prospective comparison of the effect of direct current electrical stimulation and pulsed electromagnetic fields on instrumented posterolateral lumbar arthrodesis. Journal of Spinal Disorders 2000;13(4):290‐6.

Kitchel 2002 {published data only}

Kitchel SH, Matteri RE. Prospective randomized evaluation of PLIF in degenerative spondylolisthesis patients over 60 years old. The Spine Journal 2002;2(2 Suppl):21S.

Linovitz 2002 {published data only}

Linovitz RJ, Pathria M, Bernhardt M, Green D, Law MD, McGuire RA, et al. Combined magnetic fields accelerate and increase spine fusion. A double‐blind, randomized, placebo controlled study. Spine 2002;27:1383‐9.

Madan 2003 {published data only}

Madan S, Boeree NR. Outcome of the Graf ligamentoplasty procedure compared with anterior lumbar interbody fusion with the Hartshill horseshoe cage. Eur Spine J 2003;12:361‐8.

McAfee 2003 {published data only}

Geisler FH, Blumenthal SL, Guyer RD, McAfee PC, Regan JJ, Johnson JP, et al. Neurological complications of lumbar artificial disc replacement and comparison of clinical results with those related to lumbar arthrodesis in the literature: Results of a multicenter, prospective, randomized investigational device exemption study of Charite intervertebral disc. J Neurosurg Spine 2004;1:143‐54.
Holt R, Jajd M, Isaza J, Blumnethal S, McAfee P, Guyer R, et al. Complications of lumbar artificial disc replacement vs fusion: Results from the randomized, multicenter FDA IDE study of the Charite artificial disc. Proceedings of the International Society for the Study of the Lumbar Spine.. 2005:31.
McAfee PC, Fedder IL, Saiedy S, Shucosky EM, Cunningham B. Experimental design of total disk replacement ‐ experience with a prospective randomized study of the SB Charite. Spine 2003;28(20S):S153‐62.
Whitaker C, Hochschuler S, Ohnmeiss D, Zigler J, Guyer R, Sachs B, et al. Proceedings of the International Society for the Study of the Lumbar Spine. 2005:68.

McGuire 1993 {published data only}

McGuire RA, Amundson GM. The use of primary internal fixation in spondylolisthesis. Spine 1993;18(12):1662‐72.

Moller 2000 {published data only}

Moller H, Hedlund R. [Surgery versus conservative treatment in adult isthmic spondylolisthesis. A prospective randomized study]. Thesis: Karolinska Institute. Stockholm: Kongl Carolinska Medico Chirurgiska Institute, 1999. [ISBN 91‐628‐3834‐2]
Moller H, Hedlund R. Surgery versus conservative management in adult isthmic spondylolisthesis. Spine 2000;25(13):1711‐5.
Moller H, Hedlund R. Surgery vs. conservative treatment in adult spondylolisthesis ‐ a prospective randomized study. Acta Orthop Scand. 1998; Vol. 69, issue Suppl. 280:13.
Moller H, Hedlund R. Surgery vs. conservative treatment in adult spondylolisthesis. A prospective randomised study. Orthop Trans. 1996; Vol. 20, issue 2:390.

Mooney 1990 {published data only}

Mooney V. A randomized double‐blind prospective study of the efficacy of pulsed electromagnetic fields for interbody lumbar fusions. Spine 1990;15(7):708‐12.

Pauza 2004 {published data only}

Pauza K, Howell S, Dreyfuss P, Peloza J, Park K. A randomized, double‐blind, placebo controlled trial evaluating the efficacy of intradiscal electrothermal anuloplasty (IDET) for the treatment of chronic discogenic low back pain: 6‐month outcomes. Proceedings of the International Spinal Injections Society. 2002.
Pauza KJ, Howell S, Dreyfuss P, Peloza JH, Dawson K, Bogduk N. A randomized, placebo‐controlled trail of intradiscal electrotermal therapy for the treatment of discogenic low back pain. Spine Journal 2004;4(1):27‐35.

Postacchini 1993 {published data only}

Postacchini F, Cinotti G, Perugia D, Gumina S. The surgical treatment of central lumbar stenosis. J Bone Joint Surg 1993;75‐B:386‐92.

Sasso 2004 {published data only}

Sasso RC, Kitchel SH, Dawson EG. A prospective, randomized controlled clinical trial of anterior lumbar interbody fusion using a titanium cylindrical threaded fusion device. Spine 2004;29(2):113‐22.

Schofferman 2001 {published data only}

Schofferman J, Slosar P, Reynolds J, Goldthwaite N, Koestler M. A prospective randomized comparison of 270º fusions to 360º fusions (circumferential fusions). Spine (electronic) 2001;26(10):E207‐12.

Thomsen 1997 {published data only}

Andersen T, Christensen FB, Hansen ES, Bunger C. Pain 5 years after instrumented and non‐instrumented posterolateral lumbar spinal fusion. Eur Spine J 2003;12:393‐9.
Christensen FB, Hansen ES, Laursen M, Thomsen K, Bunger CE. Long‐term functional outcome of pedicle screw instrumentation as a support for posterolateral spinal fusion. Randomized clinical study with a 5‐year follow‐up. Spine 2002;27(12):1269‐77.
Korsgaard M, Christensen FB, Thomsen K, Hansen ES, Bonger C. The effect of pedicle screw instrumentation on lordosis in lumbar spinal fusion. J Bone Joint Surg. 1999; Vol. 81‐B, issue Suppl. II:188.
Thomsen K, Christensen FB, Eiskjaer SP, Hansen ES, Fruensgaard S, Bunger CE. The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion. A prospective randomized clinical study. Spine 1997;22:2813‐22.
Thomsen K, Eiskjaer S, Hansen ES, Fruensgaard S, Christensen FB, Bunger C. Lumbar posterolateral fusion ‐ the consequences of pedicle screw instrumentation. Acta Orthop Scand. 1996; Vol. 67:48.

Zdeblick 1993 {published data only}

Zdeblick TA. A prospective, randomized study of lumbar fusion. Preliminary results [see comments]. Spine 1993;18(8):983‐91.
Zdeblick TA, Ulschmid S. An outcomes and cost analysis of pedicle screw fusions. Orthop Trans 1996;20:362‐3.

Zigler 2003 {published data only}

Whitaker C, Hochschuler SH, Ohnmeiss DD, Zigler JE, Guyer RD, Sachs BL, et al. Return to work following total disc replacement vs. fusion: A prospective randomized, comparison study. Proceedings of the International Society for Surgery of the Lumbar Spine. 2005:68.
Zigler JE, Burd TA, Vialle EN, Sachs BL, Rashbaum RF, Ohnmeiss DD. Lumbar spine arthroplasty. Early results using the ProDisc II: A prospective randomized trial of arthroplasty versus fusion. Journal of Spinal Disorders 2003;16(4):352‐61.

Zucherman 2004 {published data only}

Zucherman JF, Hsu KY, Hartjen CA, Mehalic TF, Implicito DA, Martin MJ, et al. A prospective randomized multi‐center study for the treatment of lumbar spinal stenosis with the X STOP interspinous implant: 1‐year results. Eur Spine J 2004;13:22‐31.

Boden 2002 {published data only}

Boden SD, Kang J, Sandhu H, Heller JG. Use of recombinant human bone morphogenetic protein‐2 to achieve posterolateral lumbar spine fusion in humans. Spine 2002;27:2662‐73.

Christensen 2003 {published data only}

Christensen FB, Laurberg I, Bunger CE. Importance of the back‐cafe concept to rehabilitation after lumbar spinal fusion: A randomized clinical study with a 2‐year follow‐up. Spine 2003;28(23):2561‐9.

Emery 1995 {published data only}

Emery SE, Stephens GC, Bolesta MJ. Lumbar fusion with and without instrumentation: A prospective study. [Abstract] Orthop Trans 1995;19(2):362.

Ercelen 2003 {published data only}

Ercelen O, Bulutcu E, Oktenoglu T, Sasani M, Bozkus H, Saryoglu AC, et al. Radiofrequency lesioning using two different time modalities for the treatment of lumbar discogenic pain: A randomized trial. Spine 2003;28(17):1922‐7.

Gibson S 2002 {published data only}

Gibson S, McLeod I, Wardlaw D, Urbaniak S. Allograft versus autograft in instrumented posterolateral lumbar spinal fusion: A randomized control trial. Spine 2002;27(15):1599‐1603.

Johnsson 2002 {published data only}

Johnsson R, Stromqvist B, Aspenberg P. Randomized radiostereometric study comparing osteogenic protein‐1 (BMP‐7) and autograft bone in human noninstrumented posterolateral lumbar fusion. Spine 2002;27:2654‐61.

Khot 2004 {published data only}

Khot A, Bowditch M, Powell J, Sharp D. The use of intradiscal steroid therapy for lumbar spinal discogenic pain: a randomized controlled trial. Spine 2004;29:833‐6.

Korovessis 2003 {published data only}

Korovessis P, Papazisis Z, Koureas G, Zacharatos S. Rigid vs semirigid and dynamic instrumentation for stabilization the degenerated lumbosacral spine associated with spinal stenosis. Eur Spine J. 2003; Vol. 12, issue Suppl 1:S6‐7.

Laine 2000 {published data only}

Laine T, Lund T, Ylikoski M, Lohikoski J, Schlenzka D. Accuracy of pedicle screw insertion with and without computer assistance ‐ a randomised controlled clinical study in 100 consecutive patients. ISSLS Proceedings, Adelaide, April 2000. 2000:236.

McAfee 2002 {published data only}

McAfee PC, Lee GA, Fedder IL, Cunningham BW. Anterior BAK instrumentation and fusion: complete versus partial discectomy. Clin Orthop 2002, (394):55‐63.

Moore 1995 {published data only}

Moore KR, Schlegel JD. Early outcome of prospective data for the treatment of degenerative spondylolisthesis comparing in situ fusion versus pedicle screw instrumentation and fusion. Orthop Trans. 1995; Vol. 19:62.

North 1995 {published data only}

North RB, Kidd DH, Piantadosi S. Spinal cord stimulation versus reoperation for failed back surgery syndrome: A prospective randomized study design. Acta Neurochir 1995;64:106‐8.

Rogozinski 1995 {published data only}

Rogozinski A, Rogozinski C. Efficacy of implanted bone growth stimulation in instrumented lumbosacral spinal fusion. Orthop trans 1995;19:362.

Sachs 2002 {published data only}

Sachs B, McVoy J, Miller B, Ohnmeiss D. A prospective, randomized comparison of laparoscopic to open anterior lumbar interbody fusion with cages. Proceedings of the Meeting of the Americas II, New York. 2002.

Sanden 2002 {published data only}

Sanden B, Olerud C, Petren‐Mallmin MP, Larsson S. Hydroxyapatite coating improves fixation of pedicle screws: A clinical study. J Bone Joint Surg 2002;84‐B:387‐91.

Soegaard 2003 {published data only}

Soegaard R, Christensen FB, Laurberg I, Bunger CE. Cost‐effectiveness analysis on different rehabilitation strategies after lumbar spinal fusion ‐ A randomized prospective study. Eur Spine J 2003;12(Suppl 1):S10‐11.

Transfeldt 2001 {published data only}

Transfeldt EE, Burkus JK, Kitchel SH, Watkins R, Balderston RA. A prospective and randomized study assessing the clinical and radiographic outcomes of patients treated with rhBMP‐2 and threaded cortical bone dowels in the lumbar spine. Proceedings of the British Scoliosis Society. 2001.

von Strempel 1997 {published data only}

von Strempel AH. Results of dynamic versus rigid instrumentation of the spine. J Bone Joint Surg. 1997; Vol. 79‐B:Supp IV:441.

Zdeblick 1996 {published data only}

Zdeblick TA, Ulschmid S, Dick JC. The surgical treatment of L5‐S1 degenerative disc disease ‐ A prospective randomized study of laparoscopic fusion. Orthop Transactions 1996;20:75.
Zdeblick TA, Ulschmid S, Dick JC. The surgical treatment of L5‐S1 degenerative disc disease ‐ A prospective randomized study of laparoscopic fusion. Orthopaedic Transactions 1996‐7;20:1064‐5.

Zhao 2002 {published data only}

Zhao J, Wang X, Hou T, He S. One versus two BAK fusion cages in posterior lumbar interbody fusion to L4‐L5 degenerative spondylolisthesis. Spine 2002;27:2753‐7.

Fairbank 2005 {published data only}

Fairbank J, Frost H, Wilson‐MacDonald J, Yu L, Barker K, Collins R and the Spine Stabilisation Group. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 2005;330:1233‐43.
Rivero‐Arias O, Campbell HE, Gray AM, Fairbank J, Frost H, Wilson‐MacDonald J and the Spine Stabilisation Trial Group. Surgical stabilisation of the spine compared with a programme of intensive rehabilitation for the management of patients with chronic low back pai: cost utility analysis based on a randomised controlled trial. BMJ 2005;330:1239‐43.

Ma 2001 {published data only}

Ma Y, Guo L, Cai X. Posterior interbody fusion or posterolateral fusion for discogenic low back pain. Ahonghua Yi Xue Za Zhi 2001;81(20):1253‐5.

Clarke 2003 {published data only}

A Prospective randomised trial comparing femoral ring allograft versus a titanium cage for circumferential spinal fusion: two year functional and radiological outcome. Ongoing study2001.

Freeman 2005 {published data only}

Freeman BJC, McKenna PJ, Mulholland RC, Grevitt MP, Webb JK, Mehdian SH. A prospective randomixed trial: femoral ring allograft versus a titanium cage in circumferential lumbar spinal fusion. Proc. International Society for Study of the Lumbar Spine. 2005:8.

Gibson 2003 {published data only}

Gibson JNA, Hallett A. Spinal fusion in patients with single level degenerate disc disease and neural compression ‐ A prospective randomised study. Proceedings of the International Society for Study of the Lumbar Spine. 2003.

Ilharreborde 2005 {published data only}

Ilharreborde B, Olivier E, Rillardon L, Vialle R, Guigui P. Efficiency of total disc replacement arthroplasty in the treatment of chronic low back pain. Proceedings of the International Society for the Study of the Lumbar Spine. 2005:10.

Malmivaara 2003 {published data only}

Malmivaara A, Slatis P, Heliovaara M, Sainio P, Kinnunen H, Kankare J, et al. Operative treatment for moderately severe lumbar spinal stenosis: a randomized controlled trial. Proceedings of the International Society for Study of the Lumbar Spine. 2003.

Whitaker 2005 {published data only}

Whitaker C, Hochschuler S, Ohnmeiss D, Zigler J, Guyer R, Sachs B, et al. Return to work following total disc replacement vs. fusion: A prospective, randomized, comparison study. Proceedings of the International Society for the Study of the Lumbar Spine. 2005:68.

Alderson 2003

Alderson P, Green S, Higgins JPT, Editors. The Cochrane Reviewer's Handbook 4.2 [updated December 2003]. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd, 2004, issue 1:Appendix 5c.

Blumenthal 1993

Blumenthal SL, Gill K. Can lumbar spine radiographs accurately determine fusion in post‐operative patients? Correlation of routine radiographs with a second surgical look at lumbar fusion. Spine 1993;19:1186‐9.

Bono 2004

Bono CM, Lee CK. Critical analysis of trends in fusion for degenerative disc disease over the past 20 years: influence of technique on fusion rate and clinical outcome. Spine 2004;29(4):455‐63.

Cha 2003

Cha CW, Boden SD. Gene therapy applications for spine fusion. Spine 2003;28(15):S74‐84.

Ciol 1996

Ciol MA, Deyo RA, Howell E, Krief S. An assessment of surgery for spinal stenosis time trends, geographic variations, complications and reoperations. J Amer Geront Soc 1996;44:285‐90.

Deyo 1992

Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA. Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis and procedure. J Bone Joint Surg 1992;74‐A:536‐43.

Deyo 1998

Deyo R, Battie M, Beurskens A, Bombardier C, Croft P, Koes B, et al. Outcome measures for low back pain research: a proposal for standardised use. Spine 1998;23:2003‐13.

Goosens 1998

Goosens M, Evers S. Economic evaluation of back pain interventions. In: Nachemson A, Jonsson E editor(s). SBU report on back pain. Stockholm: Swedish Council on Technology Assessment in Health Care, 1998.

Indahl 1995

Indahl A, Velund L, Reikeraas O. Good prognosis for low back pain when left untampered: a randomized clinical trial. Spine 1995;20:473‐7.

Kant 1995

Kant AP, Daum WJ, Dean SM, Vehida T. Evaluation of lumbar spine fusion. Plain radiographs versus direct surgical exploration and observation. Spine 1995;20:2313‐7.

Keller 2004

Keller A, Brox JI, Gunderson R, Holm IPT, Friis A, Reikeras O. Trunk muscle strength, cross‐sectional area and density in patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises. Spine 2004;29(1):3‐8.

Mardjetko 1994

Mardjetko SM, Connolly PJ, Shott S. Degenerative lumbar spondylosis: a meta‐analysis of the literature 1970‐1993. Spine 1994;19:2256S‐65S.

Roy‐Camille 1986

Roy‐Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop 1986;203:7‐17.

Sandhu 2003

Sandhu HS. Bone morphogenetic proteins and spinal surgery. Spine 2003;28(15):S64‐73.

Schulz 1995

Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408‐12.

Szpalski 1997

Szpalski M, Gunzburg R. Lumbar segmental instability: fact or fiction?. Proceedings of the IVth Brussels International Spine Symposium. Brussels, 1997.

Turner 1992a

Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar spinal stenosis: attempted meta‐analysis of literature 1970‐93. Spine 1992;17:1‐8.

Turner 1992b

Turner JA, Ersek M, Herron L, Haselkorn J, Kent D, Ciol MA, et al. Patient outcomes after lumbar spinal fusions. JAMA 1992;268:907‐11.

van Tulder 2003

van Tulder M, Furlan A, Bombardier C, Bouter L and the Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group. Spine 2003;28:1290‐9.

Gibson 1999

Gibson JNA, Grant IC, Waddell G. The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine 1999;24(17):1820‐32.

Gibson 2000

Gibson JNA, Waddell G, Grant IC. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2000, Issue 3. [DOI: 10.1002/14651858.CD001352]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

Amundsen 2000

Methods

Random number table
Allocation concealment: B
Lost to follow‐up: 3/31

Participants

31 participents; 16 m, 15 f;
age 21 to 70+ yrs;
Lumbar stenosis
Oslo, Norway

Interventions

Exp: Decompression
Ctl: Orthosis + "back school"

Outcomes

2nd procedure
Pain degree
measured at 10 yrs

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Barendse 2001

Methods

Randomization by computer programme.
Allocation concealment: A
Double blind
Lost to follow‐up: 0/28

Participants

28 participants; 10 m, 18 f;
age 30 to 65 yrs; Chronic discogenic pain
Maastricht, Netherlands

Interventions

Exp: IDET
Ctl: Sham

Outcomes

Observer rating
measured at 8 wks

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
Bridwell 1993

Methods

Randomization method: not stated
Allocation concealment: C
Blinding: nil
Lost to follow‐up: 1/44 at 2 yrs

Participants

44 participants; 10 m, 34 f; age 44 to 79 yrs;
Spinal claudication
St. Louis, Missouri

Interventions

Exp:
a) Instrumented posterolateral fusion (Steffee system)
b) Posterolateral fusion
Ctl: No fusion

Outcomes

Spondylolisthesis progression
2nd procedure required
Walking distance
measured at 2 yrs

Notes

Non‐randomized allocation of patients with radiological instability

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Brox 2003

Methods

Centralized randomization
Allocation concealment: A
Blinded assessor
Lost to follow‐up: 3/60

Participants

60 participants;
age 25 to 60 yrs; Chronic low back pain
Oslo, Norway

Interventions

Exp: Posterolateral instrumented fusion (pedicle systems)
Ctl: Cognitive intervention / exercises

Outcomes

Patient rating
ODI
Back pain rating
General function score
Hopkins symptom check list
Waddell's fear avoidance belief questionnaire
Work status
Analgesic use
measured at 1 yr

Notes

Treatment post laminectomy

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
Brox 2004

Methods

Block randomization from computer generated list
Allocation concealment: A
Lost to follow‐up: 3/60

Participants

60 participants
age 25 to 60 yrs; Chronic low back pain
Oslo, Norway

Interventions

Exp: Posterolateral instrumented fusion (pedicle systems)
Ctl: Modern rehabilitation programme

Outcomes

Independent observer rating
Patient rating
ODI
measured at 1 yr
Work status

Notes

Treatment post discectomy

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
Carragee 1997

Methods

Randomisation method: sealed envelopes containing random numbers.
Concealment: A
Blinding: nil
Lost to follow‐up: 2 at 4.5 yrs

Participants

42 participants; 26 m, 16 f; age 19 to 51 yrs;
Grade I/II isthmic spondylolisthesis.
Stanford, California

Interventions

Exp:
a) Smokers with instrumented arthrodesis (Texas SRH system) + decompressive laminectomy
b) Non‐smokers with graft alone + decompressive laminectomy
Ctl: Same groups without decompressive laminectomy

Outcomes

Back pain rating
Fusion
Patient rating
measured at 3 yrs

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
Christensen 2002

Methods

Randomization by consecutively numbered sealed envelopes
Allocation concealment: A
Lost to follow‐up: 9/146

Participants

148 participants; 88 m, 58 f
mean age 45, range 20 to 65 yrs; Heterogeneous conditions
Aarhus, Denmark

Interventions

Dubousset system
Exp: Circumferential fusion with ALIF Brantigan cage plus posterior instrumentation (CD system or transarticular screws)
Ctl: Instrumented posterolateral lumbar fusion (CD system)

Outcomes

Dallas pain questionnaire
Low back rating scale
Work status
measured at 2 yrs

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
Delamarter 2003

Methods

Central randomization ratio 2:1
Allocation concealment: A
Lost to follow‐up:
0/53 at 6 months

Participants

53 participants; 30 m, 25 f
age range 19 to 59 yrs; Chronic disc disease
Santa Monica, CA.

Interventions

Exp: ProDisc artificial lumbar disc replacement
Ctl: Circumferential fusion (anterior femoral ring allograft plus posterior pedicle screw instrumentation and fusion (pedicle system)

Outcomes

ODI
VAS
Sagittal motion
measured at 6 months

Notes

Interim analysis from one center out of US multi‐center trial

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
Fischgrund 1997

Methods

Randomization method: closed envelope technique
Allocation concealment: A
Blinding: assessor
Lost to follow‐up: 8/76 at 2.4 yrs.

Participants

76 participants; 17 m, 59 f; age 52 to 86 yrs; Degenerative spondylolisthesis and spinal stenosis
Royal Oak, Michigan

Interventions

Exp: Instrumented posterolateral fusion (Steffee system)
Ctl: Postero‐lateral fusion only

Outcomes

Back pain scale
Leg pain scale
Surgeon rating
Fusion
Progression of spondylolisthesis
measured at 2 yrs.

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
France 1999

Methods

Randomization method: not stated
Allocation concealment: B
Blinding: nil
Lost to follow‐up: 12/83 at 40 months

Participants

83 participants; 58 m, 25 f; age 19 to 76 yrs; Heterogeneous conditions
Multicentre‐U.S.

Interventions

Exp: Instrumented posterolateral fusion (Steffee system)
Ctl: Postero‐lateral fusion only

Outcomes

Back pain scale
Patient rating
Fusion
measured at 2 yrs

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Freeman 2003

Methods

Randomization method: 2:1 Exp:Ctl
Allcocation concealment: B
Double blind
Lost to follow‐up: 2/57

Participants

57 participants
Adelaide, Australia

Interventions

Exp: IDET
Ctl: Sham therapy

Outcomes

LBOS
ODI
SF‐36
ZDI
Modified somatic perceptions questionnaire
measured at 6 mos

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

D ‐ Not used
Fritzell 2001

Methods

Randomization blindly from computer generated list
Allocation concealment: A
Independent assessor
Lost to follow‐up: 5/294

Participants

294 participants; 50% m;
age 25 to 64 yrs; Chronic low back pain
Multicentre, Sweden

Interventions

Exp: Surgical
a) Posterolateral fusion
b) Instrumented posterolateral fusion (Steffee system)
c) Interbody (ALIF or PLIF (autogenous graft) + b)
Ctl: Non‐surgical treatment

Outcomes

Patient rating
Observer rating
Back to work
Back pain (VAS)
Oswestry disability index
Zung depression scale
General function score
measured at 2 yrs

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
Goodwin 1999

Methods

Randomization method: not stated
Allocation concealment B
Blinding: Assessor
Lost to follow‐up 158/337 at 1 yr

Participants

179 participants at follow‐up; 97 m, 82 f; age 21 to 76 yrs;
One or two level fusions ‐ PLIF, ALIF or Postero‐lateral type
Multi‐centre, New York

Interventions

Exp: Electrical stimulation
Ctl: Placebo stimulation

Outcomes

Surgeon rating
Radiographic fusion
measured at 1 yr

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Grob 1995

Methods

Randomization method: quasi by date of admission to hospital
Allocation concealment: C
Blinding: nil
Lost to follow‐up: 0/30 at 28 months

Participants

45 participants; 21 m, 24 f; age 48 to 87 yrs; Spinal stenosis
History + clinical exam + CT scan. Systemic disease excluded. Stenosis
Switzerland

Interventions

Exp: Decompression with arthrodesis (both mono + multi‐segmental)
Ctl: Decompression without arthrodesis

Outcomes

Patient rating
Surgeon rating
2nd Procedure required
measured at 28 months (mean)

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

High risk

C ‐ Inadequate
Herkowitz 1991

Methods

Quasi‐randomized: alternately assigned to treatment
Alocation concealment: B
Blinding: nil
Lost to follow‐up: 0/50 at 3 yrs.

Participants

50 participants; 14 m, 36 f; age 52 to 84 yrs; Degenerative spondylolisthesis
Royal Oak, Michigan

Interventions

Exp: Decompression + fusion
Ctl: Decompression

Outcomes

Back pain scale Leg pain scale
Surgeon rating
Fusion
Progression of spondylolisthesis
measured at 3 yrs

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

High risk

C ‐ Inadequate
Jenis 2000

Methods

Computer generated randomization
Allocation concealment: B
Lost to follow‐up: 0/61

Participants

61 participants; 32 m, 29 f;
age 18 to 75 yrs
Boston, Ma; Patients requiring posterolateral fusion

Interventions

Exp: Pulsed electromagnetic field therapy (external coil)
Exp. 2: Direct current (implanted electrode)
Ctl: Nil

Outcomes

Fusion failure
Clinical outcome
measured at 1 yr

Notes

Also measurements of fusion mass

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Kitchel 2002

Methods

Randomization method: not stated
Allocation concealment: C

Participants

62 participants; Degenerative spondylolisthesis

Interventions

Exp: Instrumented posterolateral (pedicle system) and posterior interbody fusin (autogenous graft)
Ctl: Instrumented posterolateral fusion

Outcomes

Fusion
Surgery time
Blood loss
Intraoperative
complications
Oswestry disability index change
measured at 2 yrs

Notes

Abstract of data
Insufficient for analysis

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Linovitz 2002

Methods

Randomized from computer generated randomisation code provided by independent third party.
Allocation concealment: A
Lost to follow‐up: 42/243

Participants

243 participants; mean age 57 yrs
Heterogeneous group requiring fusion without instrumentation
Multicentre, U.S.

Interventions

Exp: Active stimulation 30 min/day for 2 months
Ctl: Sham stimulation

Outcomes

Fusion by CT and/or lateral Flex/Ext radiographs
measured at 9 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
Madan 2003

Methods

Randomization from chits drawn from box
Allocation concealment: A
Loss to follow‐up: 0/55

Participants

55 participants; 29 m, 26 f; age range 25 to 70 yrs
Southampton, UK

Interventions

Exp: Ligamentoplasty (Graf system)
Ctl: Anterior lumbar interbody fusion with Hartshill horshoe cage

Outcomes

VAS
ODI
Re‐operation
measured at 2 yrs

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
McAfee 2003

Methods

Random number generator in ratio 2:1
Allocation concealment: A
Lost to follow‐up: 0/60

Participants

60 participants, 30 m, 30 f;
age range 21 to 56 yrs
Baltimore, MD

Interventions

Exp: SB Charite artificial lumbar disc replacement
Ctl: BAK anterior interbody fusion

Outcomes

ODI
Re‐operation
measured at a mean of 2 yrs

Notes

Pilot study only.
Further data published by Geisler (see references and analysis tables)

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
McGuire 1993

Methods

Randomization method: not stated
Allocation concealment: B
Blinding: nil
Lost to follow‐up: 1/27 at 2 yrs

Participants

27 participants; 23 m, 4 f; age 24 to 42 yrs;
Symptomatic grade I to II spondylolisthesis refratory to conservative care.
All treated with laminectomy + nerve root decompression
Multi‐centre, U.S.

Interventions

Exp: Postero‐lateral fusion (Steffee system)
Ctl: Posterolateral fusion only

Outcomes

Fusion,
2nd Procedure required
measured at 2 yrs.

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Moller 2000

Methods

Randomization method: blindly selected choice of three. Allocation concealment: A
Not blind.
Lost to follow‐up 8/114 randomised

Participants

111 participants; 57 m, 54 f ; 18 to 55 yrs; Isthmic spondylolisthesis of all grades
Linkoping, Sweden

Interventions

Exp.1: Instrumented posterolateral fusion (CD system)
Exp.2: Posterolateral fusion in situ
Ctl: Exercise programme

Outcomes

Disability rating index
Pain score
Assessor rating
Fusion (operated pts.)
Patient rating
Return to work
measured at 2 yrs

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
Mooney 1990

Methods

Randomization method: not stated
Allocation concealment: B
Blinding: double
Lost to follow‐up: 11/206 at 1 yr.

Participants

195 participants
Individuals undergoing initial attempts at interbody spinal fusion (anterior or posterior approach)
Irvine, California

Interventions

Exp: Electromagnetic brace ‐ 8 hrs/day
Ctl: Placebo brace ‐ 8 hrs/day

Outcomes

Surgeons rating
measured at 1 yr

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Pauza 2004

Methods

Computer generated random numbers
Allocation concealment: A
Blinding: double
Lost to follow‐up: 8/64

Participants

64 participants from a potential of 1360
Age 18 to 65 yrs; Chronic low back pain
Tyler, Texas

Interventions

Exp: IDET to 90ºC
Ctl: Sham generator
16.5 minutes

Outcomes

VAS
ODI
SF‐36
measured at 2 yrs

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
Postacchini 1993

Methods

Randomization method: Allocation by pathology and then assigned alternately
Allocation concealment: C
Blinding: nil
Lost to follow up 3/70 at 3.7 yrs.

Participants

70 participants; 34 m, 36 f; age 43 to 79 yrs;
Central lumbar stenosis
Rome, Italy

Interventions

Exp: Multiple laminotomy
Ctl: Laminectomy

Outcomes

Patient rating
Surgeon rating
Progression of spondylolisthesis
Operating time & Blood loss
measured at 3.7 yrs

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

High risk

C ‐ Inadequate
Sasso 2004

Methods

Randomization method not stated.
Allocation concealment: B
Blinding: nil
Lost to follow‐up:22/140 at 2 yrs

Participants

140 participants; 63 m, 76 f;
18 to 64 yrs;
Degenerative disc disease
Multicentre, U.S.

Interventions

Exp: Threaded fusion device (Interfix system)
Ctl: Femoral ring allograft filled with autogenous iliac crest bone

Outcomes

Radiographic fusion
ODI
SF‐36
measured at 2 yrs
Repeat surgery

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Schofferman 2001

Methods

Randomization by odd and even file numbers.
Allocation concealment: C
Lost to follow‐up: 5/53

Participants

53 participants; 27 m, 21 f;
mean age 42 yrs; Heterogeneous groups requiring fusion
Daly City, California

Interventions

Exp: 360º fusion (TSRH system plus allograft ring, plus autogenous posterolateral graft)
Ctl: 270º fusion (as above no posterolateral graft)

Outcomes

Pain
Oswestry disability index
Costs
Fusion
Re‐operation
measured at a mean of 35 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

High risk

C ‐ Inadequate
Thomsen 1997

Methods

Randomization from consecutively numbered closed envelopes
Allocation concealment: A
Blinding: assessor
Lost to follow‐up: 3/129 at 2 yrs.

Participants

130 participants; 60 m, 69 f; age 20 to 67 yrs; Chronic low back pain
Aarhus, Denmark

Interventions

Exp: Instrumented posterolateral fusion (CD system)
Ctl: Postero‐lateral fusion

Outcomes

Functional scale
Patient rating
Fusion
2nd Procedure required
measured at 2 yrs

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
Zdeblick 1993

Methods

Random number generator
Allocation concealment: C
Blinding: nil
Lost to follow‐up: 1/124

Participants

124participants; age 20 to 80 yrs; Heterogeneous conditions
Wisconsin, US

Interventions

Exp:
a) Instrumented posterolateral fusion (rigid TSRH system
b) Instrumented posterolateral fusion (semi‐rigid Luque II instrumentation
Ctl: Posterolateral fusion only

Outcomes

Surgeons rating
2nd procedure required
measured at a mean of 16 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
Zigler 2003

Methods

Randomized from central office
Allocation concealment: A
Blinding of patient and relatives until surgery. Independent assessor blinded
Lost to follow‐up: 0/39

Participants

39 participants from 1 of 19 participating centers ‐ ratio 28 Exp. to 11Ctl; age 18 to 60 yrs;
Degenerative disc disease with primarily back and/or radicular pain
Plano, Texas

Interventions

Exp: ProDisc implant
Ctl: 360 degree fusion ‐ anterior biconvex‐shaped femoral ring allograft inserted with a 6.5mm retaining cancellous screw to prevent anterior migration plus posterior instrumented fusion (unilateral single level, bilateral two level)

Outcomes

VAS
ODI
Patient satisfaction on VAS scale
Work status (unclear)
measured at 6 months

Notes

Results from 1 of 19 centers

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
Zucherman 2004

Methods

Block randomization by centre
Allocation concealment: A
Blinding: nil
Lost to follow‐up: 22/200 at 1 yr

Participants

200 pts; mean age 69 yrs
Lumbar spinal stenosis
Multi‐centre, U.S.

Interventions

Exp. Interspinous spacer (X‐stop system)
Ctl: Epidural injection, NSAIDs, Analgesics, Physical therapy

Outcomes

SF‐36
Zurich claudication questionnaire
measured at 1 yr

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Exp = Experimental
Ctl = Control
m = male
f = female
yrs = years
wks = weeks
ODI ‐ Oswestry Disability Index
PLIF = posterior lumbar interbody fusion
ALIF = anterior lumbar interbody fusion
CD system = Cotrel‐Dubousset instrumentation
ZCI = Zurich claudication questionnaire

Characteristics of excluded studies [ordered by study ID]

Ir a:

Study

Reason for exclusion

Boden 2002

Study of human bone morphogenetic protein

Christensen 2003

Study of rehabilitation following surgery

Emery 1995

No subsequent data produced following abstract in 1995

Ercelen 2003

Comparison of two durations of intradiscal radiofrequency thermocoagulation

Gibson S 2002

Study of method of achieving better fusion (allograft versus autograft)

Johnsson 2002

Study of osteogenic protein‐1

Khot 2004

Medical treatment for discogenic back pain (steroid vs. saline placebo injection).

Korovessis 2003

Randomly selected group of patients divided according to their surgery

Laine 2000

Study of technique ‐ computer assistance in placement of pedicle screws

McAfee 2002

Study of varying surgical technique

Moore 1995

Initial report of 8 patients published in 1995. No complete data.

North 1995

Preliminary data comparing the effectiveness of an implanted electrode to diminish persistent radicular and back pain after lumbosacral spine surgery with reoperation

Rogozinski 1995

No further data published after abstract in 1995

Sachs 2002

Study of technique

Sanden 2002

Variation of surgical technique ‐ hydroxyapatite coating of pedicle screws

Soegaard 2003

Study of post spinal fusion rehabilitation programmes

Transfeldt 2001

Study of bone morphogenetic proteins

von Strempel 1997

Study of two different screw types

Zdeblick 1996

No subsequent data produced following abstract in 1996

Zhao 2002

Study of variation within a given procedure

Characteristics of ongoing studies [ordered by study ID]

Ir a:

Clarke 2003

Trial name or title

A Prospective randomised trial comparing femoral ring allograft versus a titanium cage for circumferential spinal fusion: two year functional and radiological outcome

Methods

Participants

62 participants

Interventions

Exp: Titanium interbody cage
Ctl: Femoral ring allograft

Outcomes

ODI
VAS
SF‐36

Starting date

2001

Contact information

Centre for spinal surgery, Queens Medical Centre, Nottingham, UK

Notes
Freeman 2005

Trial name or title

Methods

Participants

Interventions

Outcomes

Starting date

Contact information

Notes
Gibson 2003

Trial name or title

Spinal fusion in patients with single level degenerate disc disease and neural compression ‐ a prospective randomised study

Methods

Participants

40 participants; age 39 to 74 yrs

Interventions

Exp 1: Transforaminal interbody fusion plus instrumented posterolateral fusion
Exp 2: Instrumented posterolateral fusion
Ctl: Decompression alone

Outcomes

Roland & Morris
EuroQol
SF‐36
DPQ

Starting date

1999

Contact information

[email protected]

Notes
Ilharreborde 2005

Trial name or title

Methods

Participants

Interventions

Outcomes

Starting date

Contact information

Notes
Malmivaara 2003

Trial name or title

Operative treatment for moderately severe lumbar spinal stenosis: a randomized controlled trial

Methods

Participants

94 participants

Interventions

Exp: Segmental decompression and undercutting facetectomy
Ctl: Conservative treatment ‐ analgesia & self‐administered exercises guided by a physiotherapist

Outcomes

VAS
ODI
Walking ability on a treadmill

Starting date

2001

Contact information

Finnish Institute of Occupational Health, Helsinki

Notes
Whitaker 2005

Trial name or title

Methods

Participants

Interventions

Outcomes

Starting date

Contact information

Notes

Data and analyses

Open in table viewer
Comparison 1. DECOMPRESSION vs CONSERVATIVE

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Secondary surgery by 4 years Show forest plot

1

30

Odds Ratio (M‐H, Random, 95% CI)

0.09 [0.01, 0.89]
Analysis 1.1
Comparison 1 DECOMPRESSION vs CONSERVATIVE, Outcome 1 Secondary surgery by 4 years.

Comparison 1 DECOMPRESSION vs CONSERVATIVE, Outcome 1 Secondary surgery by 4 years.

2 Bad result at 10 years Show forest plot

1

19

Odds Ratio (M‐H, Random, 95% CI)

2.43 [0.09, 67.57]
Analysis 1.2
Comparison 1 DECOMPRESSION vs CONSERVATIVE, Outcome 2 Bad result at 10 years.

Comparison 1 DECOMPRESSION vs CONSERVATIVE, Outcome 2 Bad result at 10 years.
Open in table viewer
Comparison 2. MULTIPLE LAMINOTOMY vs LAMINECTOMY

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 No success: combined patient / surgeon rating Show forest plot

1

67

Odds Ratio (M‐H, Random, 95% CI)

0.85 [0.25, 2.88]
Analysis 2.1
Comparison 2 MULTIPLE LAMINOTOMY vs LAMINECTOMY, Outcome 1 No success: combined patient / surgeon rating.

Comparison 2 MULTIPLE LAMINOTOMY vs LAMINECTOMY, Outcome 1 No success: combined patient / surgeon rating.

2 Spondylolisthesis progression Show forest plot

1

67

Odds Ratio (M‐H, Random, 95% CI)

0.56 [0.16, 2.03]
Analysis 2.2
Comparison 2 MULTIPLE LAMINOTOMY vs LAMINECTOMY, Outcome 2 Spondylolisthesis progression.

Comparison 2 MULTIPLE LAMINOTOMY vs LAMINECTOMY, Outcome 2 Spondylolisthesis progression.
Open in table viewer
Comparison 3. LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Poor result 18‐24 months ‐ Surgeon rating Show forest plot

3

138

Odds Ratio (M‐H, Random, 95% CI)

0.44 [0.13, 1.48]
Analysis 3.1
Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 1 Poor result 18‐24 months ‐ Surgeon rating.

Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 1 Poor result 18‐24 months ‐ Surgeon rating.

2 Re‐operation 2‐4 years Show forest plot

2

64

Odds Ratio (M‐H, Random, 95% CI)

4.69 [0.51, 42.83]
Analysis 3.2
Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 2 Re‐operation 2‐4 years.

Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 2 Re‐operation 2‐4 years.

3 Spondylolisthesis progression Show forest plot

2

93

Odds Ratio (M‐H, Random, 95% CI)

0.09 [0.00, 2.07]
Analysis 3.3
Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 3 Spondylolisthesis progression.

Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 3 Spondylolisthesis progression.

4 No improvement in walking distance Show forest plot

1

39

Odds Ratio (M‐H, Random, 95% CI)

0.38 [0.06, 2.21]
Analysis 3.4
Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 4 No improvement in walking distance.

Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 4 No improvement in walking distance.

5 Good result at 18‐24 months Show forest plot

2

93

Odds Ratio (M‐H, Random, 95% CI)

4.41 [1.09, 17.76]
Analysis 3.5
Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 5 Good result at 18‐24 months.

Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 5 Good result at 18‐24 months.

6 No spondylolisthesis progression Show forest plot

2

93

Odds Ratio (M‐H, Random, 95% CI)

11.53 [0.48, 275.52]
Analysis 3.6
Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 6 No spondylolisthesis progression.

Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 6 No spondylolisthesis progression.

Open in table viewer
Comparison 4. LAMINECTOMY PLUS MULTI‐LEVEL FUSION vs LAMINECTOMY

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Poor result as rated by patient ‐ at 2yrs Show forest plot

1

30

Odds Ratio (M‐H, Random, 95% CI)

5.74 [0.25, 130.37]
Analysis 4.1
Comparison 4 LAMINECTOMY PLUS MULTI‐LEVEL FUSION vs LAMINECTOMY, Outcome 1 Poor result as rated by patient ‐ at 2yrs.

Comparison 4 LAMINECTOMY PLUS MULTI‐LEVEL FUSION vs LAMINECTOMY, Outcome 1 Poor result as rated by patient ‐ at 2yrs.

2 Poor result as rated by independent assessor ‐ at 2yrs Show forest plot

1

30

Odds Ratio (M‐H, Random, 95% CI)

8.68 [0.41, 184.28]
Analysis 4.2
Comparison 4 LAMINECTOMY PLUS MULTI‐LEVEL FUSION vs LAMINECTOMY, Outcome 2 Poor result as rated by independent assessor ‐ at 2yrs.

Comparison 4 LAMINECTOMY PLUS MULTI‐LEVEL FUSION vs LAMINECTOMY, Outcome 2 Poor result as rated by independent assessor ‐ at 2yrs.

3 Re‐operation by 28mths Show forest plot

1

30

Odds Ratio (M‐H, Random, 95% CI)

3.21 [0.12, 85.20]
Analysis 4.3
Comparison 4 LAMINECTOMY PLUS MULTI‐LEVEL FUSION vs LAMINECTOMY, Outcome 3 Re‐operation by 28mths.

Comparison 4 LAMINECTOMY PLUS MULTI‐LEVEL FUSION vs LAMINECTOMY, Outcome 3 Re‐operation by 28mths.

Open in table viewer
Comparison 5. LAMINECTOMY vs NO LAMINECTOMY (Isthmic spondylolisthesis)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 No fusion at 4.5yrs Show forest plot

1

42

Odds Ratio (M‐H, Random, 95% CI)

15.21 [0.76, 303.32]
Analysis 5.1
Comparison 5 LAMINECTOMY vs NO LAMINECTOMY (Isthmic spondylolisthesis), Outcome 1 No fusion at 4.5yrs.

Comparison 5 LAMINECTOMY vs NO LAMINECTOMY (Isthmic spondylolisthesis), Outcome 1 No fusion at 4.5yrs.

2 No success ‐ Patient rating at 4.5yrs Show forest plot

1

42

Odds Ratio (M‐H, Random, 95% CI)

11.5 [1.24, 106.85]
Analysis 5.2
Comparison 5 LAMINECTOMY vs NO LAMINECTOMY (Isthmic spondylolisthesis), Outcome 2 No success ‐ Patient rating at 4.5yrs.

Comparison 5 LAMINECTOMY vs NO LAMINECTOMY (Isthmic spondylolisthesis), Outcome 2 No success ‐ Patient rating at 4.5yrs.

Open in table viewer
Comparison 6. LAMINECTOMY PLUS ONE LEVEL FUSION (No instrumentation, spinal stenosis + degen spondylolisthesis vs LAMINECT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Poor result as rated by surgeon ‐ at 36 mths (ave) Show forest plot

1

50

Odds Ratio (M‐H, Random, 95% CI)

0.18 [0.01, 4.04]
Analysis 6.1
Comparison 6 LAMINECTOMY PLUS ONE LEVEL FUSION (No instrumentation, spinal stenosis + degen spondylolisthesis vs LAMINECT, Outcome 1 Poor result as rated by surgeon ‐ at 36 mths (ave).

Comparison 6 LAMINECTOMY PLUS ONE LEVEL FUSION (No instrumentation, spinal stenosis + degen spondylolisthesis vs LAMINECT, Outcome 1 Poor result as rated by surgeon ‐ at 36 mths (ave).

2 Spondylolisthesis progression at 6 months Show forest plot

1

19

Odds Ratio (M‐H, Random, 95% CI)

4.67 [0.67, 32.36]
Analysis 6.2
Comparison 6 LAMINECTOMY PLUS ONE LEVEL FUSION (No instrumentation, spinal stenosis + degen spondylolisthesis vs LAMINECT, Outcome 2 Spondylolisthesis progression at 6 months.

Comparison 6 LAMINECTOMY PLUS ONE LEVEL FUSION (No instrumentation, spinal stenosis + degen spondylolisthesis vs LAMINECT, Outcome 2 Spondylolisthesis progression at 6 months.

3 Re‐operation required within 4 years Show forest plot

1

19

Odds Ratio (M‐H, Random, 95% CI)

3.00 [0.11, 83.36]
Analysis 6.3
Comparison 6 LAMINECTOMY PLUS ONE LEVEL FUSION (No instrumentation, spinal stenosis + degen spondylolisthesis vs LAMINECT, Outcome 3 Re‐operation required within 4 years.

Comparison 6 LAMINECTOMY PLUS ONE LEVEL FUSION (No instrumentation, spinal stenosis + degen spondylolisthesis vs LAMINECT, Outcome 3 Re‐operation required within 4 years.

Open in table viewer
Comparison 7. LUMBAR FUSION vs CONSERVATIVE (PHYSICAL) THERAPY

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fair or Poor outcome (independent observer rated) Show forest plot

1

262

Odds Ratio (M‐H, Random, 95% CI)

0.26 [0.13, 0.52]
Analysis 7.1
Comparison 7 LUMBAR FUSION vs CONSERVATIVE (PHYSICAL) THERAPY, Outcome 1 Fair or Poor outcome (independent observer rated).

Comparison 7 LUMBAR FUSION vs CONSERVATIVE (PHYSICAL) THERAPY, Outcome 1 Fair or Poor outcome (independent observer rated).

2 Not back to work at 2 years Show forest plot

1

208

Odds Ratio (M‐H, Random, 95% CI)

0.26 [0.10, 0.64]
Analysis 7.2
Comparison 7 LUMBAR FUSION vs CONSERVATIVE (PHYSICAL) THERAPY, Outcome 2 Not back to work at 2 years.

Comparison 7 LUMBAR FUSION vs CONSERVATIVE (PHYSICAL) THERAPY, Outcome 2 Not back to work at 2 years.

3 Unchanged / worse at two years (patient rating) Show forest plot

1

257

Odds Ratio (M‐H, Random, 95% CI)

0.28 [0.15, 0.53]
Analysis 7.3
Comparison 7 LUMBAR FUSION vs CONSERVATIVE (PHYSICAL) THERAPY, Outcome 3 Unchanged / worse at two years (patient rating).

Comparison 7 LUMBAR FUSION vs CONSERVATIVE (PHYSICAL) THERAPY, Outcome 3 Unchanged / worse at two years (patient rating).

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Comparison 8. LUMBAR FUSION vs COGNITIVE EXERCISES (Degenerate disc)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure (patient rating) at 1 year Show forest plot

1

61

Odds Ratio (M‐H, Random, 95% CI)

0.76 [0.25, 2.25]
Analysis 8.1
Comparison 8 LUMBAR FUSION vs COGNITIVE EXERCISES (Degenerate disc), Outcome 1 Failure (patient rating) at 1 year.

Comparison 8 LUMBAR FUSION vs COGNITIVE EXERCISES (Degenerate disc), Outcome 1 Failure (patient rating) at 1 year.

2 Failure (independent assessor) at 1 year Show forest plot

2

63

Odds Ratio (M‐H, Random, 95% CI)

1.53 [0.48, 4.87]
Analysis 8.2
Comparison 8 LUMBAR FUSION vs COGNITIVE EXERCISES (Degenerate disc), Outcome 2 Failure (independent assessor) at 1 year.

Comparison 8 LUMBAR FUSION vs COGNITIVE EXERCISES (Degenerate disc), Outcome 2 Failure (independent assessor) at 1 year.

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Comparison 9. INSTRUMENTED FUSION vs COGNITIVE EXERCISES (Post discectomy)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure (patient rating) Show forest plot

1

57

Odds Ratio (M‐H, Fixed, 95% CI)

1.07 [0.38, 3.03]
Analysis 9.1
Comparison 9 INSTRUMENTED FUSION vs COGNITIVE EXERCISES (Post discectomy), Outcome 1 Failure (patient rating).

Comparison 9 INSTRUMENTED FUSION vs COGNITIVE EXERCISES (Post discectomy), Outcome 1 Failure (patient rating).

2 Failure (Independent observer rating) Show forest plot

1

57

Odds Ratio (M‐H, Fixed, 95% CI)

1.42 [0.49, 4.08]
Analysis 9.2
Comparison 9 INSTRUMENTED FUSION vs COGNITIVE EXERCISES (Post discectomy), Outcome 2 Failure (Independent observer rating).

Comparison 9 INSTRUMENTED FUSION vs COGNITIVE EXERCISES (Post discectomy), Outcome 2 Failure (Independent observer rating).

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Comparison 10. POSTERO‐LATERAL FUSION +/‐ INSTRUMENTATION vs EXERCISE THERAPY (Isthmic spondylolisthesis)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Sick leave post treatment Show forest plot

1

106

Odds Ratio (M‐H, Random, 95% CI)

1.06 [0.46, 2.46]
Analysis 10.1
Comparison 10 POSTERO‐LATERAL FUSION +/‐ INSTRUMENTATION vs EXERCISE THERAPY (Isthmic spondylolisthesis), Outcome 1 Sick leave post treatment.

Comparison 10 POSTERO‐LATERAL FUSION +/‐ INSTRUMENTATION vs EXERCISE THERAPY (Isthmic spondylolisthesis), Outcome 1 Sick leave post treatment.

2 Failure ‐ patient rating Show forest plot

1

109

Odds Ratio (M‐H, Random, 95% CI)

0.23 [0.10, 0.53]
Analysis 10.2
Comparison 10 POSTERO‐LATERAL FUSION +/‐ INSTRUMENTATION vs EXERCISE THERAPY (Isthmic spondylolisthesis), Outcome 2 Failure ‐ patient rating.

Comparison 10 POSTERO‐LATERAL FUSION +/‐ INSTRUMENTATION vs EXERCISE THERAPY (Isthmic spondylolisthesis), Outcome 2 Failure ‐ patient rating.

3 Failure ‐ Assessor rating Show forest plot

1

109

Odds Ratio (M‐H, Random, 95% CI)

0.09 [0.03, 0.23]
Analysis 10.3
Comparison 10 POSTERO‐LATERAL FUSION +/‐ INSTRUMENTATION vs EXERCISE THERAPY (Isthmic spondylolisthesis), Outcome 3 Failure ‐ Assessor rating.

Comparison 10 POSTERO‐LATERAL FUSION +/‐ INSTRUMENTATION vs EXERCISE THERAPY (Isthmic spondylolisthesis), Outcome 3 Failure ‐ Assessor rating.

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Comparison 11. INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Poor result as rated by patient ‐ at >2yrs Show forest plot

1

45

Odds Ratio (M‐H, Random, 95% CI)

1.3 [0.22, 7.64]
Analysis 11.1
Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 1 Poor result as rated by patient ‐ at >2yrs.

Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 1 Poor result as rated by patient ‐ at >2yrs.

2 Poor result at 2yrs ‐ surgeon rating Show forest plot

2

113

Odds Ratio (M‐H, Random, 95% CI)

1.96 [0.63, 6.16]
Analysis 11.2
Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 2 Poor result at 2yrs ‐ surgeon rating.

Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 2 Poor result at 2yrs ‐ surgeon rating.

3 Re‐operation at 28mths average Show forest plot

1

45

Odds Ratio (M‐H, Random, 95% CI)

6.69 [0.35, 129.43]
Analysis 11.3
Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 3 Re‐operation at 28mths average.

Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 3 Re‐operation at 28mths average.

4 Spondylolisthesis progression Show forest plot

1

33

Odds Ratio (M‐H, Random, 95% CI)

0.05 [0.00, 0.60]
Analysis 11.4
Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 4 Spondylolisthesis progression.

Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 4 Spondylolisthesis progression.

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Comparison 12. INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fair/Poor outcome at 1 ‐ 2yr ‐ Surgeon rating Show forest plot

3

193

Odds Ratio (M‐H, Random, 95% CI)

0.58 [0.08, 4.26]
Analysis 12.1
Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 1 Fair/Poor outcome at 1 ‐ 2yr ‐ Surgeon rating.

Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 1 Fair/Poor outcome at 1 ‐ 2yr ‐ Surgeon rating.

2 2nd procedure by 2yrs Show forest plot

7

494

Odds Ratio (M‐H, Random, 95% CI)

1.05 [0.40, 2.73]
Analysis 12.2
Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 2 2nd procedure by 2yrs.

Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 2 2nd procedure by 2yrs.

3 No fusion at 2 yrs Show forest plot

8

638

Odds Ratio (M‐H, Random, 95% CI)

0.43 [0.21, 0.91]
Analysis 12.3
Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 3 No fusion at 2 yrs.

Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 3 No fusion at 2 yrs.

4 Poor clinical outcome Show forest plot

8

653

Odds Ratio (M‐H, Random, 95% CI)

0.49 [0.28, 0.84]
Analysis 12.4
Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 4 Poor clinical outcome.

Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 4 Poor clinical outcome.

5 Re‐operation at 5 years Show forest plot

1

120

Odds Ratio (M‐H, Random, 95% CI)

2.65 [1.08, 6.51]
Analysis 12.5
Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 5 Re‐operation at 5 years.

Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 5 Re‐operation at 5 years.

6 Pain score at 5 years Show forest plot

1

109

Mean Difference (IV, Random, 95% CI)

0.03 [‐1.12, 1.18]
Analysis 12.6
Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 6 Pain score at 5 years.

Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 6 Pain score at 5 years.

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Comparison 13. INSTRUMENTED FUSION vs NON‐INSTRUMENTED FUSION (Isthmic spondylolisthesis)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure ‐ Patient rating at 2 yr Show forest plot

1

75

Odds Ratio (M‐H, Random, 95% CI)

0.37 [0.12, 1.12]
Analysis 13.1
Comparison 13 INSTRUMENTED FUSION vs NON‐INSTRUMENTED FUSION (Isthmic spondylolisthesis), Outcome 1 Failure ‐ Patient rating at 2 yr.

Comparison 13 INSTRUMENTED FUSION vs NON‐INSTRUMENTED FUSION (Isthmic spondylolisthesis), Outcome 1 Failure ‐ Patient rating at 2 yr.

2 Failure ‐ Assessor rating Show forest plot

1

75

Odds Ratio (M‐H, Random, 95% CI)

0.70 [0.25, 1.92]
Analysis 13.2
Comparison 13 INSTRUMENTED FUSION vs NON‐INSTRUMENTED FUSION (Isthmic spondylolisthesis), Outcome 2 Failure ‐ Assessor rating.

Comparison 13 INSTRUMENTED FUSION vs NON‐INSTRUMENTED FUSION (Isthmic spondylolisthesis), Outcome 2 Failure ‐ Assessor rating.

3 Failed fusion (definitely not solid) Show forest plot

1

74

Odds Ratio (M‐H, Random, 95% CI)

0.51 [0.18, 1.43]
Analysis 13.3
Comparison 13 INSTRUMENTED FUSION vs NON‐INSTRUMENTED FUSION (Isthmic spondylolisthesis), Outcome 3 Failed fusion (definitely not solid).

Comparison 13 INSTRUMENTED FUSION vs NON‐INSTRUMENTED FUSION (Isthmic spondylolisthesis), Outcome 3 Failed fusion (definitely not solid).

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Comparison 14. INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fusion failure Show forest plot

2

201

Odds Ratio (M‐H, Random, 95% CI)

1.08 [0.51, 2.29]
Analysis 14.1
Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 1 Fusion failure.

Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 1 Fusion failure.

2 Complications Show forest plot

2

201

Odds Ratio (M‐H, Random, 95% CI)

1.00 [0.24, 4.17]
Analysis 14.2
Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 2 Complications.

Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 2 Complications.

3 Not much better Show forest plot

1

149

Odds Ratio (M‐H, Random, 95% CI)

1.18 [0.59, 2.33]
Analysis 14.3
Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 3 Not much better.

Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 3 Not much better.

4 Re‐operation Show forest plot

1

139

Odds Ratio (M‐H, Random, 95% CI)

0.25 [0.09, 0.74]
Analysis 14.4
Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 4 Re‐operation.

Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 4 Re‐operation.

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Comparison 15. ALIF PLUS POSTEROLATERAL INSTRUMENTED vs ALIF plus INSTRUMENTED

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fusion failure Show forest plot

1

40

Odds Ratio (M‐H, Random, 95% CI)

2.35 [0.40, 13.90]
Analysis 15.1
Comparison 15 ALIF PLUS POSTEROLATERAL INSTRUMENTED vs ALIF plus INSTRUMENTED, Outcome 1 Fusion failure.

Comparison 15 ALIF PLUS POSTEROLATERAL INSTRUMENTED vs ALIF plus INSTRUMENTED, Outcome 1 Fusion failure.

2 Re‐operation Show forest plot

1

48

Odds Ratio (M‐H, Random, 95% CI)

0.91 [0.28, 2.96]
Analysis 15.2
Comparison 15 ALIF PLUS POSTEROLATERAL INSTRUMENTED vs ALIF plus INSTRUMENTED, Outcome 2 Re‐operation.

Comparison 15 ALIF PLUS POSTEROLATERAL INSTRUMENTED vs ALIF plus INSTRUMENTED, Outcome 2 Re‐operation.

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Comparison 16. GRAF LIGAMENTOPLASTY vs ANTERIOR LUMBAR CAGED FUSION

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Re‐operation Show forest plot

1

56

Odds Ratio (M‐H, Random, 95% CI)

0.32 [0.01, 8.24]
Analysis 16.1
Comparison 16 GRAF LIGAMENTOPLASTY vs ANTERIOR LUMBAR CAGED FUSION, Outcome 1 Re‐operation.

Comparison 16 GRAF LIGAMENTOPLASTY vs ANTERIOR LUMBAR CAGED FUSION, Outcome 1 Re‐operation.
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Comparison 17. ANTERIOR THREADED CAGE vs FEMORAL RING FUSION

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure of fusion Show forest plot

1

118

Odds Ratio (M‐H, Fixed, 95% CI)

0.03 [0.01, 0.15]
Analysis 17.1
Comparison 17 ANTERIOR THREADED CAGE vs FEMORAL RING FUSION, Outcome 1 Failure of fusion.

Comparison 17 ANTERIOR THREADED CAGE vs FEMORAL RING FUSION, Outcome 1 Failure of fusion.

2 Secondary procedure Show forest plot

1

139

Odds Ratio (M‐H, Fixed, 95% CI)

0.38 [0.18, 0.76]
Analysis 17.2
Comparison 17 ANTERIOR THREADED CAGE vs FEMORAL RING FUSION, Outcome 2 Secondary procedure.

Comparison 17 ANTERIOR THREADED CAGE vs FEMORAL RING FUSION, Outcome 2 Secondary procedure.
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Comparison 18. IDET vs SHAM

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 No success (observer rated) ‐ at 8 weeks Show forest plot

1

28

Odds Ratio (M‐H, Random, 95% CI)

1.85 [0.15, 23.07]
Analysis 18.1
Comparison 18 IDET vs SHAM, Outcome 1 No success (observer rated) ‐ at 8 weeks.

Comparison 18 IDET vs SHAM, Outcome 1 No success (observer rated) ‐ at 8 weeks.
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Comparison 19. ANY FORM OF ELECTRICAL STIMULATION vs PLACEBO

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure of fusion with internal fixation Show forest plot

3

290

Odds Ratio (M‐H, Random, 95% CI)

0.59 [0.15, 2.30]
Analysis 19.1
Comparison 19 ANY FORM OF ELECTRICAL STIMULATION vs PLACEBO, Outcome 1 Failure of fusion with internal fixation.

Comparison 19 ANY FORM OF ELECTRICAL STIMULATION vs PLACEBO, Outcome 1 Failure of fusion with internal fixation.

2 Failure of fusion without internal fixation Show forest plot

3

268

Odds Ratio (M‐H, Random, 95% CI)

0.38 [0.22, 0.64]
Analysis 19.2
Comparison 19 ANY FORM OF ELECTRICAL STIMULATION vs PLACEBO, Outcome 2 Failure of fusion without internal fixation.

Comparison 19 ANY FORM OF ELECTRICAL STIMULATION vs PLACEBO, Outcome 2 Failure of fusion without internal fixation.

3 Poor clincical outcome Show forest plot

3

357

Odds Ratio (M‐H, Random, 95% CI)

0.58 [0.27, 1.24]
Analysis 19.3
Comparison 19 ANY FORM OF ELECTRICAL STIMULATION vs PLACEBO, Outcome 3 Poor clincical outcome.

Comparison 19 ANY FORM OF ELECTRICAL STIMULATION vs PLACEBO, Outcome 3 Poor clincical outcome.

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Comparison 20. X‐STOP INTERSPINOUS IMPLANT vs CONTROL

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Secondary surgery Show forest plot

1

196

Odds Ratio (M‐H, Random, 95% CI)

0.26 [0.09, 0.73]
Analysis 20.1
Comparison 20 X‐STOP INTERSPINOUS IMPLANT vs CONTROL, Outcome 1 Secondary surgery.

Comparison 20 X‐STOP INTERSPINOUS IMPLANT vs CONTROL, Outcome 1 Secondary surgery.

2 Moderate or severe pain Show forest plot

1

167

Odds Ratio (M‐H, Random, 95% CI)

0.14 [0.07, 0.29]
Analysis 20.2
Comparison 20 X‐STOP INTERSPINOUS IMPLANT vs CONTROL, Outcome 2 Moderate or severe pain.

Comparison 20 X‐STOP INTERSPINOUS IMPLANT vs CONTROL, Outcome 2 Moderate or severe pain.

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Comparison 21. CHARITE DISC REPLACEMENT vs BAK ANTERIOR INTERBODY FUSION

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Oswestry Disability Index at 2 years Show forest plot

1

258

Mean Difference (IV, Random, 95% CI)

‐4.30 [‐10.28, 1.68]
Analysis 21.1
Comparison 21 CHARITE DISC REPLACEMENT vs BAK ANTERIOR INTERBODY FUSION, Outcome 1 Oswestry Disability Index at 2 years.

Comparison 21 CHARITE DISC REPLACEMENT vs BAK ANTERIOR INTERBODY FUSION, Outcome 1 Oswestry Disability Index at 2 years.

2 VAS‐pain Show forest plot

1

258

Mean Difference (IV, Random, 95% CI)

‐5.70 [‐13.71, 2.31]
Analysis 21.2
Comparison 21 CHARITE DISC REPLACEMENT vs BAK ANTERIOR INTERBODY FUSION, Outcome 2 VAS‐pain.

Comparison 21 CHARITE DISC REPLACEMENT vs BAK ANTERIOR INTERBODY FUSION, Outcome 2 VAS‐pain.

3 Device failure Show forest plot

1

304

Odds Ratio (M‐H, Random, 95% CI)

0.88 [0.32, 2.45]
Analysis 21.3
Comparison 21 CHARITE DISC REPLACEMENT vs BAK ANTERIOR INTERBODY FUSION, Outcome 3 Device failure.

Comparison 21 CHARITE DISC REPLACEMENT vs BAK ANTERIOR INTERBODY FUSION, Outcome 3 Device failure.

Comparison 1 DECOMPRESSION vs CONSERVATIVE, Outcome 1 Secondary surgery by 4 years.
Figuras y tablas -
Analysis 1.1

Comparison 1 DECOMPRESSION vs CONSERVATIVE, Outcome 1 Secondary surgery by 4 years.

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Comparison 1 DECOMPRESSION vs CONSERVATIVE, Outcome 2 Bad result at 10 years.
Figuras y tablas -
Analysis 1.2

Comparison 1 DECOMPRESSION vs CONSERVATIVE, Outcome 2 Bad result at 10 years.

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Comparison 2 MULTIPLE LAMINOTOMY vs LAMINECTOMY, Outcome 1 No success: combined patient / surgeon rating.
Figuras y tablas -
Analysis 2.1

Comparison 2 MULTIPLE LAMINOTOMY vs LAMINECTOMY, Outcome 1 No success: combined patient / surgeon rating.

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Comparison 2 MULTIPLE LAMINOTOMY vs LAMINECTOMY, Outcome 2 Spondylolisthesis progression.
Figuras y tablas -
Analysis 2.2

Comparison 2 MULTIPLE LAMINOTOMY vs LAMINECTOMY, Outcome 2 Spondylolisthesis progression.

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Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 1 Poor result 18‐24 months ‐ Surgeon rating.
Figuras y tablas -
Analysis 3.1

Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 1 Poor result 18‐24 months ‐ Surgeon rating.

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Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 2 Re‐operation 2‐4 years.
Figuras y tablas -
Analysis 3.2

Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 2 Re‐operation 2‐4 years.

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Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 3 Spondylolisthesis progression.
Figuras y tablas -
Analysis 3.3

Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 3 Spondylolisthesis progression.

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Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 4 No improvement in walking distance.
Figuras y tablas -
Analysis 3.4

Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 4 No improvement in walking distance.

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Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 5 Good result at 18‐24 months.
Figuras y tablas -
Analysis 3.5

Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 5 Good result at 18‐24 months.

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Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 6 No spondylolisthesis progression.
Figuras y tablas -
Analysis 3.6

Comparison 3 LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY, Outcome 6 No spondylolisthesis progression.

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Comparison 4 LAMINECTOMY PLUS MULTI‐LEVEL FUSION vs LAMINECTOMY, Outcome 1 Poor result as rated by patient ‐ at 2yrs.
Figuras y tablas -
Analysis 4.1

Comparison 4 LAMINECTOMY PLUS MULTI‐LEVEL FUSION vs LAMINECTOMY, Outcome 1 Poor result as rated by patient ‐ at 2yrs.

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Comparison 4 LAMINECTOMY PLUS MULTI‐LEVEL FUSION vs LAMINECTOMY, Outcome 2 Poor result as rated by independent assessor ‐ at 2yrs.
Figuras y tablas -
Analysis 4.2

Comparison 4 LAMINECTOMY PLUS MULTI‐LEVEL FUSION vs LAMINECTOMY, Outcome 2 Poor result as rated by independent assessor ‐ at 2yrs.

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Comparison 4 LAMINECTOMY PLUS MULTI‐LEVEL FUSION vs LAMINECTOMY, Outcome 3 Re‐operation by 28mths.
Figuras y tablas -
Analysis 4.3

Comparison 4 LAMINECTOMY PLUS MULTI‐LEVEL FUSION vs LAMINECTOMY, Outcome 3 Re‐operation by 28mths.

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Comparison 5 LAMINECTOMY vs NO LAMINECTOMY (Isthmic spondylolisthesis), Outcome 1 No fusion at 4.5yrs.
Figuras y tablas -
Analysis 5.1

Comparison 5 LAMINECTOMY vs NO LAMINECTOMY (Isthmic spondylolisthesis), Outcome 1 No fusion at 4.5yrs.

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Comparison 5 LAMINECTOMY vs NO LAMINECTOMY (Isthmic spondylolisthesis), Outcome 2 No success ‐ Patient rating at 4.5yrs.
Figuras y tablas -
Analysis 5.2

Comparison 5 LAMINECTOMY vs NO LAMINECTOMY (Isthmic spondylolisthesis), Outcome 2 No success ‐ Patient rating at 4.5yrs.

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Comparison 6 LAMINECTOMY PLUS ONE LEVEL FUSION (No instrumentation, spinal stenosis + degen spondylolisthesis vs LAMINECT, Outcome 1 Poor result as rated by surgeon ‐ at 36 mths (ave).
Figuras y tablas -
Analysis 6.1

Comparison 6 LAMINECTOMY PLUS ONE LEVEL FUSION (No instrumentation, spinal stenosis + degen spondylolisthesis vs LAMINECT, Outcome 1 Poor result as rated by surgeon ‐ at 36 mths (ave).

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Comparison 6 LAMINECTOMY PLUS ONE LEVEL FUSION (No instrumentation, spinal stenosis + degen spondylolisthesis vs LAMINECT, Outcome 2 Spondylolisthesis progression at 6 months.
Figuras y tablas -
Analysis 6.2

Comparison 6 LAMINECTOMY PLUS ONE LEVEL FUSION (No instrumentation, spinal stenosis + degen spondylolisthesis vs LAMINECT, Outcome 2 Spondylolisthesis progression at 6 months.

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Comparison 6 LAMINECTOMY PLUS ONE LEVEL FUSION (No instrumentation, spinal stenosis + degen spondylolisthesis vs LAMINECT, Outcome 3 Re‐operation required within 4 years.
Figuras y tablas -
Analysis 6.3

Comparison 6 LAMINECTOMY PLUS ONE LEVEL FUSION (No instrumentation, spinal stenosis + degen spondylolisthesis vs LAMINECT, Outcome 3 Re‐operation required within 4 years.

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Comparison 7 LUMBAR FUSION vs CONSERVATIVE (PHYSICAL) THERAPY, Outcome 1 Fair or Poor outcome (independent observer rated).
Figuras y tablas -
Analysis 7.1

Comparison 7 LUMBAR FUSION vs CONSERVATIVE (PHYSICAL) THERAPY, Outcome 1 Fair or Poor outcome (independent observer rated).

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Comparison 7 LUMBAR FUSION vs CONSERVATIVE (PHYSICAL) THERAPY, Outcome 2 Not back to work at 2 years.
Figuras y tablas -
Analysis 7.2

Comparison 7 LUMBAR FUSION vs CONSERVATIVE (PHYSICAL) THERAPY, Outcome 2 Not back to work at 2 years.

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Comparison 7 LUMBAR FUSION vs CONSERVATIVE (PHYSICAL) THERAPY, Outcome 3 Unchanged / worse at two years (patient rating).
Figuras y tablas -
Analysis 7.3

Comparison 7 LUMBAR FUSION vs CONSERVATIVE (PHYSICAL) THERAPY, Outcome 3 Unchanged / worse at two years (patient rating).

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Comparison 8 LUMBAR FUSION vs COGNITIVE EXERCISES (Degenerate disc), Outcome 1 Failure (patient rating) at 1 year.
Figuras y tablas -
Analysis 8.1

Comparison 8 LUMBAR FUSION vs COGNITIVE EXERCISES (Degenerate disc), Outcome 1 Failure (patient rating) at 1 year.

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Comparison 8 LUMBAR FUSION vs COGNITIVE EXERCISES (Degenerate disc), Outcome 2 Failure (independent assessor) at 1 year.
Figuras y tablas -
Analysis 8.2

Comparison 8 LUMBAR FUSION vs COGNITIVE EXERCISES (Degenerate disc), Outcome 2 Failure (independent assessor) at 1 year.

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Comparison 9 INSTRUMENTED FUSION vs COGNITIVE EXERCISES (Post discectomy), Outcome 1 Failure (patient rating).
Figuras y tablas -
Analysis 9.1

Comparison 9 INSTRUMENTED FUSION vs COGNITIVE EXERCISES (Post discectomy), Outcome 1 Failure (patient rating).

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Comparison 9 INSTRUMENTED FUSION vs COGNITIVE EXERCISES (Post discectomy), Outcome 2 Failure (Independent observer rating).
Figuras y tablas -
Analysis 9.2

Comparison 9 INSTRUMENTED FUSION vs COGNITIVE EXERCISES (Post discectomy), Outcome 2 Failure (Independent observer rating).

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Comparison 10 POSTERO‐LATERAL FUSION +/‐ INSTRUMENTATION vs EXERCISE THERAPY (Isthmic spondylolisthesis), Outcome 1 Sick leave post treatment.
Figuras y tablas -
Analysis 10.1

Comparison 10 POSTERO‐LATERAL FUSION +/‐ INSTRUMENTATION vs EXERCISE THERAPY (Isthmic spondylolisthesis), Outcome 1 Sick leave post treatment.

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Comparison 10 POSTERO‐LATERAL FUSION +/‐ INSTRUMENTATION vs EXERCISE THERAPY (Isthmic spondylolisthesis), Outcome 2 Failure ‐ patient rating.
Figuras y tablas -
Analysis 10.2

Comparison 10 POSTERO‐LATERAL FUSION +/‐ INSTRUMENTATION vs EXERCISE THERAPY (Isthmic spondylolisthesis), Outcome 2 Failure ‐ patient rating.

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Comparison 10 POSTERO‐LATERAL FUSION +/‐ INSTRUMENTATION vs EXERCISE THERAPY (Isthmic spondylolisthesis), Outcome 3 Failure ‐ Assessor rating.
Figuras y tablas -
Analysis 10.3

Comparison 10 POSTERO‐LATERAL FUSION +/‐ INSTRUMENTATION vs EXERCISE THERAPY (Isthmic spondylolisthesis), Outcome 3 Failure ‐ Assessor rating.

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Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 1 Poor result as rated by patient ‐ at >2yrs.
Figuras y tablas -
Analysis 11.1

Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 1 Poor result as rated by patient ‐ at >2yrs.

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Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 2 Poor result at 2yrs ‐ surgeon rating.
Figuras y tablas -
Analysis 11.2

Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 2 Poor result at 2yrs ‐ surgeon rating.

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Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 3 Re‐operation at 28mths average.
Figuras y tablas -
Analysis 11.3

Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 3 Re‐operation at 28mths average.

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Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 4 Spondylolisthesis progression.
Figuras y tablas -
Analysis 11.4

Comparison 11 INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level), Outcome 4 Spondylolisthesis progression.

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Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 1 Fair/Poor outcome at 1 ‐ 2yr ‐ Surgeon rating.
Figuras y tablas -
Analysis 12.1

Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 1 Fair/Poor outcome at 1 ‐ 2yr ‐ Surgeon rating.

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Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 2 2nd procedure by 2yrs.
Figuras y tablas -
Analysis 12.2

Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 2 2nd procedure by 2yrs.

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Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 3 No fusion at 2 yrs.
Figuras y tablas -
Analysis 12.3

Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 3 No fusion at 2 yrs.

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Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 4 Poor clinical outcome.
Figuras y tablas -
Analysis 12.4

Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 4 Poor clinical outcome.

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Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 5 Re‐operation at 5 years.
Figuras y tablas -
Analysis 12.5

Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 5 Re‐operation at 5 years.

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Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 6 Pain score at 5 years.
Figuras y tablas -
Analysis 12.6

Comparison 12 INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease), Outcome 6 Pain score at 5 years.

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Comparison 13 INSTRUMENTED FUSION vs NON‐INSTRUMENTED FUSION (Isthmic spondylolisthesis), Outcome 1 Failure ‐ Patient rating at 2 yr.
Figuras y tablas -
Analysis 13.1

Comparison 13 INSTRUMENTED FUSION vs NON‐INSTRUMENTED FUSION (Isthmic spondylolisthesis), Outcome 1 Failure ‐ Patient rating at 2 yr.

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Comparison 13 INSTRUMENTED FUSION vs NON‐INSTRUMENTED FUSION (Isthmic spondylolisthesis), Outcome 2 Failure ‐ Assessor rating.
Figuras y tablas -
Analysis 13.2

Comparison 13 INSTRUMENTED FUSION vs NON‐INSTRUMENTED FUSION (Isthmic spondylolisthesis), Outcome 2 Failure ‐ Assessor rating.

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Comparison 13 INSTRUMENTED FUSION vs NON‐INSTRUMENTED FUSION (Isthmic spondylolisthesis), Outcome 3 Failed fusion (definitely not solid).
Figuras y tablas -
Analysis 13.3

Comparison 13 INSTRUMENTED FUSION vs NON‐INSTRUMENTED FUSION (Isthmic spondylolisthesis), Outcome 3 Failed fusion (definitely not solid).

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Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 1 Fusion failure.
Figuras y tablas -
Analysis 14.1

Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 1 Fusion failure.

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Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 2 Complications.
Figuras y tablas -
Analysis 14.2

Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 2 Complications.

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Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 3 Not much better.
Figuras y tablas -
Analysis 14.3

Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 3 Not much better.

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Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 4 Re‐operation.
Figuras y tablas -
Analysis 14.4

Comparison 14 INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION, Outcome 4 Re‐operation.

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Comparison 15 ALIF PLUS POSTEROLATERAL INSTRUMENTED vs ALIF plus INSTRUMENTED, Outcome 1 Fusion failure.
Figuras y tablas -
Analysis 15.1

Comparison 15 ALIF PLUS POSTEROLATERAL INSTRUMENTED vs ALIF plus INSTRUMENTED, Outcome 1 Fusion failure.

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Comparison 15 ALIF PLUS POSTEROLATERAL INSTRUMENTED vs ALIF plus INSTRUMENTED, Outcome 2 Re‐operation.
Figuras y tablas -
Analysis 15.2

Comparison 15 ALIF PLUS POSTEROLATERAL INSTRUMENTED vs ALIF plus INSTRUMENTED, Outcome 2 Re‐operation.

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Comparison 16 GRAF LIGAMENTOPLASTY vs ANTERIOR LUMBAR CAGED FUSION, Outcome 1 Re‐operation.
Figuras y tablas -
Analysis 16.1

Comparison 16 GRAF LIGAMENTOPLASTY vs ANTERIOR LUMBAR CAGED FUSION, Outcome 1 Re‐operation.

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Comparison 17 ANTERIOR THREADED CAGE vs FEMORAL RING FUSION, Outcome 1 Failure of fusion.
Figuras y tablas -
Analysis 17.1

Comparison 17 ANTERIOR THREADED CAGE vs FEMORAL RING FUSION, Outcome 1 Failure of fusion.

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Comparison 17 ANTERIOR THREADED CAGE vs FEMORAL RING FUSION, Outcome 2 Secondary procedure.
Figuras y tablas -
Analysis 17.2

Comparison 17 ANTERIOR THREADED CAGE vs FEMORAL RING FUSION, Outcome 2 Secondary procedure.

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Comparison 18 IDET vs SHAM, Outcome 1 No success (observer rated) ‐ at 8 weeks.
Figuras y tablas -
Analysis 18.1

Comparison 18 IDET vs SHAM, Outcome 1 No success (observer rated) ‐ at 8 weeks.

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Comparison 19 ANY FORM OF ELECTRICAL STIMULATION vs PLACEBO, Outcome 1 Failure of fusion with internal fixation.
Figuras y tablas -
Analysis 19.1

Comparison 19 ANY FORM OF ELECTRICAL STIMULATION vs PLACEBO, Outcome 1 Failure of fusion with internal fixation.

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Comparison 19 ANY FORM OF ELECTRICAL STIMULATION vs PLACEBO, Outcome 2 Failure of fusion without internal fixation.
Figuras y tablas -
Analysis 19.2

Comparison 19 ANY FORM OF ELECTRICAL STIMULATION vs PLACEBO, Outcome 2 Failure of fusion without internal fixation.

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Comparison 19 ANY FORM OF ELECTRICAL STIMULATION vs PLACEBO, Outcome 3 Poor clincical outcome.
Figuras y tablas -
Analysis 19.3

Comparison 19 ANY FORM OF ELECTRICAL STIMULATION vs PLACEBO, Outcome 3 Poor clincical outcome.

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Comparison 20 X‐STOP INTERSPINOUS IMPLANT vs CONTROL, Outcome 1 Secondary surgery.
Figuras y tablas -
Analysis 20.1

Comparison 20 X‐STOP INTERSPINOUS IMPLANT vs CONTROL, Outcome 1 Secondary surgery.

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Comparison 20 X‐STOP INTERSPINOUS IMPLANT vs CONTROL, Outcome 2 Moderate or severe pain.
Figuras y tablas -
Analysis 20.2

Comparison 20 X‐STOP INTERSPINOUS IMPLANT vs CONTROL, Outcome 2 Moderate or severe pain.

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Comparison 21 CHARITE DISC REPLACEMENT vs BAK ANTERIOR INTERBODY FUSION, Outcome 1 Oswestry Disability Index at 2 years.
Figuras y tablas -
Analysis 21.1

Comparison 21 CHARITE DISC REPLACEMENT vs BAK ANTERIOR INTERBODY FUSION, Outcome 1 Oswestry Disability Index at 2 years.

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Comparison 21 CHARITE DISC REPLACEMENT vs BAK ANTERIOR INTERBODY FUSION, Outcome 2 VAS‐pain.
Figuras y tablas -
Analysis 21.2

Comparison 21 CHARITE DISC REPLACEMENT vs BAK ANTERIOR INTERBODY FUSION, Outcome 2 VAS‐pain.

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Comparison 21 CHARITE DISC REPLACEMENT vs BAK ANTERIOR INTERBODY FUSION, Outcome 3 Device failure.
Figuras y tablas -
Analysis 21.3

Comparison 21 CHARITE DISC REPLACEMENT vs BAK ANTERIOR INTERBODY FUSION, Outcome 3 Device failure.

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Comparison 1. DECOMPRESSION vs CONSERVATIVE

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Secondary surgery by 4 years Show forest plot

1

30

Odds Ratio (M‐H, Random, 95% CI)

0.09 [0.01, 0.89]

2 Bad result at 10 years Show forest plot

1

19

Odds Ratio (M‐H, Random, 95% CI)

2.43 [0.09, 67.57]
Figuras y tablas -
Comparison 1. DECOMPRESSION vs CONSERVATIVE
Ir a la tabla de la revisión
Comparison 2. MULTIPLE LAMINOTOMY vs LAMINECTOMY

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 No success: combined patient / surgeon rating Show forest plot

1

67

Odds Ratio (M‐H, Random, 95% CI)

0.85 [0.25, 2.88]

2 Spondylolisthesis progression Show forest plot

1

67

Odds Ratio (M‐H, Random, 95% CI)

0.56 [0.16, 2.03]
Figuras y tablas -
Comparison 2. MULTIPLE LAMINOTOMY vs LAMINECTOMY
Ir a la tabla de la revisión
Comparison 3. LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Poor result 18‐24 months ‐ Surgeon rating Show forest plot

3

138

Odds Ratio (M‐H, Random, 95% CI)

0.44 [0.13, 1.48]

2 Re‐operation 2‐4 years Show forest plot

2

64

Odds Ratio (M‐H, Random, 95% CI)

4.69 [0.51, 42.83]

3 Spondylolisthesis progression Show forest plot

2

93

Odds Ratio (M‐H, Random, 95% CI)

0.09 [0.00, 2.07]

4 No improvement in walking distance Show forest plot

1

39

Odds Ratio (M‐H, Random, 95% CI)

0.38 [0.06, 2.21]

5 Good result at 18‐24 months Show forest plot

2

93

Odds Ratio (M‐H, Random, 95% CI)

4.41 [1.09, 17.76]

6 No spondylolisthesis progression Show forest plot

2

93

Odds Ratio (M‐H, Random, 95% CI)

11.53 [0.48, 275.52]
Figuras y tablas -
Comparison 3. LAMINECTOMY + FUSION ANY TYPE vs LAMINECTOMY
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Comparison 4. LAMINECTOMY PLUS MULTI‐LEVEL FUSION vs LAMINECTOMY

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Poor result as rated by patient ‐ at 2yrs Show forest plot

1

30

Odds Ratio (M‐H, Random, 95% CI)

5.74 [0.25, 130.37]

2 Poor result as rated by independent assessor ‐ at 2yrs Show forest plot

1

30

Odds Ratio (M‐H, Random, 95% CI)

8.68 [0.41, 184.28]

3 Re‐operation by 28mths Show forest plot

1

30

Odds Ratio (M‐H, Random, 95% CI)

3.21 [0.12, 85.20]
Figuras y tablas -
Comparison 4. LAMINECTOMY PLUS MULTI‐LEVEL FUSION vs LAMINECTOMY
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Comparison 5. LAMINECTOMY vs NO LAMINECTOMY (Isthmic spondylolisthesis)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 No fusion at 4.5yrs Show forest plot

1

42

Odds Ratio (M‐H, Random, 95% CI)

15.21 [0.76, 303.32]

2 No success ‐ Patient rating at 4.5yrs Show forest plot

1

42

Odds Ratio (M‐H, Random, 95% CI)

11.5 [1.24, 106.85]
Figuras y tablas -
Comparison 5. LAMINECTOMY vs NO LAMINECTOMY (Isthmic spondylolisthesis)
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Comparison 6. LAMINECTOMY PLUS ONE LEVEL FUSION (No instrumentation, spinal stenosis + degen spondylolisthesis vs LAMINECT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Poor result as rated by surgeon ‐ at 36 mths (ave) Show forest plot

1

50

Odds Ratio (M‐H, Random, 95% CI)

0.18 [0.01, 4.04]

2 Spondylolisthesis progression at 6 months Show forest plot

1

19

Odds Ratio (M‐H, Random, 95% CI)

4.67 [0.67, 32.36]

3 Re‐operation required within 4 years Show forest plot

1

19

Odds Ratio (M‐H, Random, 95% CI)

3.00 [0.11, 83.36]
Figuras y tablas -
Comparison 6. LAMINECTOMY PLUS ONE LEVEL FUSION (No instrumentation, spinal stenosis + degen spondylolisthesis vs LAMINECT
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Comparison 7. LUMBAR FUSION vs CONSERVATIVE (PHYSICAL) THERAPY

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fair or Poor outcome (independent observer rated) Show forest plot

1

262

Odds Ratio (M‐H, Random, 95% CI)

0.26 [0.13, 0.52]

2 Not back to work at 2 years Show forest plot

1

208

Odds Ratio (M‐H, Random, 95% CI)

0.26 [0.10, 0.64]

3 Unchanged / worse at two years (patient rating) Show forest plot

1

257

Odds Ratio (M‐H, Random, 95% CI)

0.28 [0.15, 0.53]
Figuras y tablas -
Comparison 7. LUMBAR FUSION vs CONSERVATIVE (PHYSICAL) THERAPY
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Comparison 8. LUMBAR FUSION vs COGNITIVE EXERCISES (Degenerate disc)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure (patient rating) at 1 year Show forest plot

1

61

Odds Ratio (M‐H, Random, 95% CI)

0.76 [0.25, 2.25]

2 Failure (independent assessor) at 1 year Show forest plot

2

63

Odds Ratio (M‐H, Random, 95% CI)

1.53 [0.48, 4.87]
Figuras y tablas -
Comparison 8. LUMBAR FUSION vs COGNITIVE EXERCISES (Degenerate disc)
Ir a la tabla de la revisión
Comparison 9. INSTRUMENTED FUSION vs COGNITIVE EXERCISES (Post discectomy)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure (patient rating) Show forest plot

1

57

Odds Ratio (M‐H, Fixed, 95% CI)

1.07 [0.38, 3.03]

2 Failure (Independent observer rating) Show forest plot

1

57

Odds Ratio (M‐H, Fixed, 95% CI)

1.42 [0.49, 4.08]
Figuras y tablas -
Comparison 9. INSTRUMENTED FUSION vs COGNITIVE EXERCISES (Post discectomy)
Ir a la tabla de la revisión
Comparison 10. POSTERO‐LATERAL FUSION +/‐ INSTRUMENTATION vs EXERCISE THERAPY (Isthmic spondylolisthesis)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Sick leave post treatment Show forest plot

1

106

Odds Ratio (M‐H, Random, 95% CI)

1.06 [0.46, 2.46]

2 Failure ‐ patient rating Show forest plot

1

109

Odds Ratio (M‐H, Random, 95% CI)

0.23 [0.10, 0.53]

3 Failure ‐ Assessor rating Show forest plot

1

109

Odds Ratio (M‐H, Random, 95% CI)

0.09 [0.03, 0.23]
Figuras y tablas -
Comparison 10. POSTERO‐LATERAL FUSION +/‐ INSTRUMENTATION vs EXERCISE THERAPY (Isthmic spondylolisthesis)
Ir a la tabla de la revisión
Comparison 11. INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Poor result as rated by patient ‐ at >2yrs Show forest plot

1

45

Odds Ratio (M‐H, Random, 95% CI)

1.3 [0.22, 7.64]

2 Poor result at 2yrs ‐ surgeon rating Show forest plot

2

113

Odds Ratio (M‐H, Random, 95% CI)

1.96 [0.63, 6.16]

3 Re‐operation at 28mths average Show forest plot

1

45

Odds Ratio (M‐H, Random, 95% CI)

6.69 [0.35, 129.43]

4 Spondylolisthesis progression Show forest plot

1

33

Odds Ratio (M‐H, Random, 95% CI)

0.05 [0.00, 0.60]
Figuras y tablas -
Comparison 11. INSTRUMENTED FUSION vs LAMINECTOMY (mixed, single/multi‐level)
Ir a la tabla de la revisión
Comparison 12. INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fair/Poor outcome at 1 ‐ 2yr ‐ Surgeon rating Show forest plot

3

193

Odds Ratio (M‐H, Random, 95% CI)

0.58 [0.08, 4.26]

2 2nd procedure by 2yrs Show forest plot

7

494

Odds Ratio (M‐H, Random, 95% CI)

1.05 [0.40, 2.73]

3 No fusion at 2 yrs Show forest plot

8

638

Odds Ratio (M‐H, Random, 95% CI)

0.43 [0.21, 0.91]

4 Poor clinical outcome Show forest plot

8

653

Odds Ratio (M‐H, Random, 95% CI)

0.49 [0.28, 0.84]

5 Re‐operation at 5 years Show forest plot

1

120

Odds Ratio (M‐H, Random, 95% CI)

2.65 [1.08, 6.51]

6 Pain score at 5 years Show forest plot

1

109

Mean Difference (IV, Random, 95% CI)

0.03 [‐1.12, 1.18]
Figuras y tablas -
Comparison 12. INSTRUMENTED POSTEROLATERAL FUSION vs GRAFT ONLY (mixed disease)
Ir a la tabla de la revisión
Comparison 13. INSTRUMENTED FUSION vs NON‐INSTRUMENTED FUSION (Isthmic spondylolisthesis)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure ‐ Patient rating at 2 yr Show forest plot

1

75

Odds Ratio (M‐H, Random, 95% CI)

0.37 [0.12, 1.12]

2 Failure ‐ Assessor rating Show forest plot

1

75

Odds Ratio (M‐H, Random, 95% CI)

0.70 [0.25, 1.92]

3 Failed fusion (definitely not solid) Show forest plot

1

74

Odds Ratio (M‐H, Random, 95% CI)

0.51 [0.18, 1.43]
Figuras y tablas -
Comparison 13. INSTRUMENTED FUSION vs NON‐INSTRUMENTED FUSION (Isthmic spondylolisthesis)
Ir a la tabla de la revisión
Comparison 14. INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fusion failure Show forest plot

2

201

Odds Ratio (M‐H, Random, 95% CI)

1.08 [0.51, 2.29]

2 Complications Show forest plot

2

201

Odds Ratio (M‐H, Random, 95% CI)

1.00 [0.24, 4.17]

3 Not much better Show forest plot

1

149

Odds Ratio (M‐H, Random, 95% CI)

1.18 [0.59, 2.33]

4 Re‐operation Show forest plot

1

139

Odds Ratio (M‐H, Random, 95% CI)

0.25 [0.09, 0.74]
Figuras y tablas -
Comparison 14. INTERBODY FUSION + POSTEROLATERAL FUSION vs POSTERLATERAL FUSION
Ir a la tabla de la revisión
Comparison 15. ALIF PLUS POSTEROLATERAL INSTRUMENTED vs ALIF plus INSTRUMENTED

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fusion failure Show forest plot

1

40

Odds Ratio (M‐H, Random, 95% CI)

2.35 [0.40, 13.90]

2 Re‐operation Show forest plot

1

48

Odds Ratio (M‐H, Random, 95% CI)

0.91 [0.28, 2.96]
Figuras y tablas -
Comparison 15. ALIF PLUS POSTEROLATERAL INSTRUMENTED vs ALIF plus INSTRUMENTED
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Comparison 16. GRAF LIGAMENTOPLASTY vs ANTERIOR LUMBAR CAGED FUSION

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Re‐operation Show forest plot

1

56

Odds Ratio (M‐H, Random, 95% CI)

0.32 [0.01, 8.24]
Figuras y tablas -
Comparison 16. GRAF LIGAMENTOPLASTY vs ANTERIOR LUMBAR CAGED FUSION
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Comparison 17. ANTERIOR THREADED CAGE vs FEMORAL RING FUSION

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure of fusion Show forest plot

1

118

Odds Ratio (M‐H, Fixed, 95% CI)

0.03 [0.01, 0.15]

2 Secondary procedure Show forest plot

1

139

Odds Ratio (M‐H, Fixed, 95% CI)

0.38 [0.18, 0.76]
Figuras y tablas -
Comparison 17. ANTERIOR THREADED CAGE vs FEMORAL RING FUSION
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Comparison 18. IDET vs SHAM

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 No success (observer rated) ‐ at 8 weeks Show forest plot

1

28

Odds Ratio (M‐H, Random, 95% CI)

1.85 [0.15, 23.07]
Figuras y tablas -
Comparison 18. IDET vs SHAM
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Comparison 19. ANY FORM OF ELECTRICAL STIMULATION vs PLACEBO

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure of fusion with internal fixation Show forest plot

3

290

Odds Ratio (M‐H, Random, 95% CI)

0.59 [0.15, 2.30]

2 Failure of fusion without internal fixation Show forest plot

3

268

Odds Ratio (M‐H, Random, 95% CI)

0.38 [0.22, 0.64]

3 Poor clincical outcome Show forest plot

3

357

Odds Ratio (M‐H, Random, 95% CI)

0.58 [0.27, 1.24]
Figuras y tablas -
Comparison 19. ANY FORM OF ELECTRICAL STIMULATION vs PLACEBO
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Comparison 20. X‐STOP INTERSPINOUS IMPLANT vs CONTROL

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Secondary surgery Show forest plot

1

196

Odds Ratio (M‐H, Random, 95% CI)

0.26 [0.09, 0.73]

2 Moderate or severe pain Show forest plot

1

167

Odds Ratio (M‐H, Random, 95% CI)

0.14 [0.07, 0.29]
Figuras y tablas -
Comparison 20. X‐STOP INTERSPINOUS IMPLANT vs CONTROL
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Comparison 21. CHARITE DISC REPLACEMENT vs BAK ANTERIOR INTERBODY FUSION

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Oswestry Disability Index at 2 years Show forest plot

1

258

Mean Difference (IV, Random, 95% CI)

‐4.30 [‐10.28, 1.68]

2 VAS‐pain Show forest plot

1

258

Mean Difference (IV, Random, 95% CI)

‐5.70 [‐13.71, 2.31]

3 Device failure Show forest plot

1

304

Odds Ratio (M‐H, Random, 95% CI)

0.88 [0.32, 2.45]
Figuras y tablas -
Comparison 21. CHARITE DISC REPLACEMENT vs BAK ANTERIOR INTERBODY FUSION
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