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. 2023 Feb 27;94(8):657–666. doi: 10.1136/jnnp-2022-330158

Table 2.

Characteristics of the included randomised controlled trials and baseline data

Author, year
country
Participants Definition of DS Surgical approach Outcomes Risk of bias domains FU (months) Interventions Sample size Age (years), mean (SD) Gender (female), n (%) Degree of vertebral slip (mm), mean (SD) Dynamic instability, n (%) VAS-back, mean (SD) VAS-leg, mean (SD)
Austevoll, et al 2021
NORDSTEN-DS trial
Norway24
18–80 years; neurogenic claudication or radicular radiating pain in the lower limbs that had not responded to at least 3 months of conservative care; LSS; DS≥3 mm
Mix of stable and instable
Dynamic instability—slippage of at least 3 mm, or at least 10 degrees of angulation, as assessed by dynamic standing radiographs Posterior decompression (with or without preservation of midline structures) was used, followed by implantation of pedicle screws with rods and bone grafting across the level of spondylolisthesis, with optional use of an intervertebral fusion device ODI, ZCQ, NRS back and leg, EQ-5D-3L, duration of surgery and length of hospital
Stay, complications and reoperations and the percentage of patients who responded that their condition was ‘much worse’ or ‘worse than ever’ on the Global Perceived Effect scale
True randomisation of 1:1 ratio
Allocation: computer-generated, stratified according to centre in blocks of 4–6
Blinding: patients likely not blinded; Investigators (outcome assessment) blinded
Modified intention-to-treat analysis: all patients who received the trial treatment in accordance with the randomisation with available data (with imputations for missing data)
3, 24 D 133 66.0±7.4 92 (69.2) 7.6 (3.2) 35 (26) 6.7±2.0 6.6±2.0
DF 129 66.5±7.9 88 (68.2) 7.2 (2.8) 27 (21) 6.7±2.1 6.7±2.1
Försth, et al 2016
Sweden28
LSS with or without DS (only those with DS used in this review); 50 and 80 years
Mix of stable and instable (not measured)
Conventional lateral radiography
(flexion–extension radiographs were not obtained); forward slip ≥3 mm
Method determined by surgeon ODI, EQ-5D, VAS back and leg, ZCQ, patient reported outcomes (satisfaction), 6 min walk test 24 and 60 D 68 67 (7) 56 (82.4) 7.4 (2.8) 6.3 (2.4) 6.5 (2.2)
DF 67 68 (7) 51 (76.1) 7.4 (2.6) 6.4 (2.0) 6.4 (2.1)
Ghogawala, et al 2016
SLIP trial
USA27
DS, grade I, LSS and neurogenic claudication with or without lumbar radiculopathy; only stable (motion≤3 mm) 3–14 mm (mean 1.3 and 1.6) Posterolateral instrumented fusion (a lumbar laminectomy as well as implantation of pedicle screws and titanium alloy rods across the level of listhesis, with a bone graft harvested from the iliac crest) SF-36 physical component, ODI, complications and reoperations, blood loss, operative time, and length of stay 12, 24 and 48 D 35 66.5 (8.0) 27 (77) 6.5 (2.3)
DF 31 66.7 (7.2) 26 (84) 5.6 (2.2)
Inose, et al 2018
Japan26
One level LSS with DS at the L4/5 level
Mix of stable and instable
>3 mm of spondylolisthesis of the L4 vertebra on a plain lateral radiograph
Dynamic instability—change of >10 degrees of angulation or >4 mm of translation of the vertebrae between flexion and extension of the spine
Posterolateral fusion with autogenous iliac bone graft and pedicle screw fixation JOA, VAS back and leg, duration of operation, blood loss, duration of postoperative hospital stay and major intraoperative and perioperative complications, degree of progression of slippage (>5%) at postoperative year 5 12, 60, 144 D 29 63.4 (8.6) 12 (41) 6.5 (2.2) 12 (41) 5.28 (3.11)* 6.21 (2.3)*
DF 31 61.2 (6.7) 20 (65) 8.1 (3.8) 13 (42) 6.28 (3.01)* 7.68 (2.51)*

*Unpublished data from authors.

D, decompression only; DF, decompression with fusion; DS, degenerative spondylolisthesis; EQ-5D, European Quality of Life–5 Dimensions; FU, follow-up; JOA, Japanese Orthopaedic Association score; LSS, lumbar spinal stenosis; NRS, numeric rating scale; ODI, Oswestry Disability Index; SF-36, Short Form 36 Health Survey Questionnaire; VAS, visual analogue scale; ZCQ, Zurich Claudication Questionnaire.