Summary of findings for the main comparison. SUMMARY OF FINDINGS FOR DECOMPRESSION VERSUS FUSION.
| Decompression alone compared with decompression plus fusion for lumbar spinal stenosis | ||||||
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Patient or population: patients with lumbar spinal stenosis Settings: inpatient care Intervention: decompression alone Comparison: decompression plus fusion | ||||||
| Outcomes | Comparisons | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Decompression | Decompression with fusion | |||||
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Pain Long‐term (≥ 12 months) Pain scores converted to 0 to 100 scale to allow for comparison of different disability scales (VAS, NRS) |
The mean pain score ranged across decompression groups from 9.50 to 48.10 points | The mean pain in the decompression with fusion groups was 0.29 higher (6.74 lower to 7.32 higher) | Mean difference ‐0.29 (‐7.32, 6.74) | 380 (4) | ⊕⊝⊝⊝ Very low | The difference is not statistically or clinically significant |
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Disability Long‐term (≥ 12 months) Disability scores converted to 0 to 100 scale to allow for comparison of different disability scales (RMDQ, ODI, JOA) |
The mean pain score ranged across decompression groups from 17.90 to 56.29 points | The mean disability score in the decompression with fusion group was 3.26 lower (6.12 lower to 12.63 higher) | Mean difference 3.26 (‐6.12, 12.63) | 335 (3) | ⊕⊝⊝⊝ Very low | The difference is not statistically or clinically significant |
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Operation time Duration of operation reported in minutes |
The mean operation time ranged across decompression groups from 88.46 minutes to 124.40 minutes | The mean operation time in the decompression with fusion groups was 107.94 higher (54.23 to 161.65 higher) | Mean difference ‐107.94 (‐161.65, ‐54.23) | 381 (4) | ⊕⊝⊝⊝ Very low | The difference is clinically significant |
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Blood loss Amount of perioperative blood loss reported in L |
The mean perioperative blood loss ranged across decompression groups from 0.08 to 0.34 L | The mean perioperative blood loss in the decompression with fusion groups was 0.52 L higher (0.34 L to 0.70 L higher) | Mean difference ‐0.52 (‐0.70, ‐0.34) | 383 (4) | ⊕⊝⊝⊝ Very low | The difference is clinically significant |
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Reoperations Number of patients requiring a revision surgery |
36 of 185 (19 per 100) participants had reoperation | 38 of 258 (15 per 100) participants had reoperation | Risk ratio 1.25 (0.81, 1.92) | 443 (5) | ⊕⊕⊕⊝ Moderate | The difference is not statistically or clinically significant |
| CI: confidence interval; VAS: visual analogue scale; NRS: numerical rating scale; RMDQ: Roland‐Morris Disability Questionnaire; ODI: Oswestry Disability Index; JOA: Japanese Orthopedic Association | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||