Young 1980.

Methods	Randomised, parallel group, two arm, active controlled, open label, two‐centre trial
Participants	Inclusion: tissue diagnosis of a malignant tumour not of central nervous system origin; the presence of clinical symptoms of cord compression; and a myelogram showing extradural lesion or block that correlated with clinical presentation Exclusion: prior radiotherapy, unfit for surgery, more than one lesion, presence of only spinal or radicular pain. Age: 19 to 83 years Gender: not stated Pretreatment ambulant: laminectomy plus radiotherapy versus radiotherapy alone: 6 versus 5 Performance status: not stated Type of primary tumours: all types Visceral metastasis: not stated Duration and rapidity of cord compression: not stated Spinal level: not stated Spinal instability: not stated
Interventions	Intervention laminectomy with radiotherapy: 30 Gy in 10 fractions over 14 days + steroids* (N = 16) Control radiotherapy: 30 Gy in 10 fractions (4 Gy/day first 3 days, then 18 Gy in 7 fractions over 14 days) + steroids* (N = 13) Timing of intervention in relation to development of cord compression ‐ not stated Concomitant medications: *Dexamethasone 12 mg stat followed by 4 mg four times daily till radiotherapy completion; other medications ‐not reported
Outcomes	Outcomes reported and used: Ambulation (ability to take steps alone with or without a cane or walker at four months): overall ambulatory rates, proportion maintaining ambulation and proportion regaining ambulation Survival Pain relief: Reduction in analgesic use Urinary continence: overall, proportion maintaining and regaining continence Adverse effects Outcomes reported but not used: Mean survival (no SD) Outcomes sought but not reported: Local recurrence Quality of life, Participant and caregiver satisfaction, Characteristics of patients who benefit the treatment
Notes	Setting: two centres in USA Period of study: not reported Provision for rehabilitation: not reported Source of funding: not reported Comments: radiotherapy alone: mortality ‐ 24% (due to underlying disease) duration of follow‐up: participants were followed up at regular intervals until death; duration unclear
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomisation was carried out using a "table of random numbers"
Allocation concealment (selection bias)	High risk	Not stated; there were also baseline imbalances in prognostic variables that might have occurred due to lack of stratification
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Lack of blinding could have led to differential interventions in terms of pain medication; though no differences were noted with interventions
Blinding of outcome assessment (detection bias) Objective outcomes	Low risk	Ambulatory status was clearly defined and minimised the possibility of observer bias
Blinding of outcome assessment (detection bias) Subjective outcomes	Unclear risk	While subjective outcomes were operationally defined, detection bias cannot be ruled out in this open label trial
Incomplete outcome data (attrition bias) Efficacy outcomes	Low risk	There was no attrition
Incomplete outcome data (attrition bias) Adverse events	Low risk	As above
Selective reporting (reporting bias)	Low risk	The trial protocol was not available but all relevant outcomes were reported
Other bias	Low risk	No other sources of bias were identified

MRI ‐ magnetic resonance imaging
 CT‐ computed tomography
 ECOG ‐ Eastern Co‐operative Oncology Group
 SD ‐ standard deviation
 Gy ‐ Gray