for the main comparison.
| Decompression ±fusion vs usual conservative care for Oswestry Disabilty Index and Visual Analogue Pain Scale (VAS) for lumbar spinal stenosis | |||||
|
Patient or population: lumbar spinal stenosis Intervention: decompression ± fusion Comparison: usual conservative care | |||||
| Outcomes | Relative effect (95% CI) | Outcome means | Number of participants (studies) | Quality of the evidence (GRADE) | |
|
Oswestry Disability Index ‐ 6 months (0 to 100%) |
(MD ‐3.66%, 95% CI ‐10.12 to 2.80) | Decompression range: 20.7 to 28.1 Usual conservative care range: 28.3 to 29.0 |
349 (2) | ⊕⊕⊝⊝ Low | |
|
Oswestry Disability Index ‐ 1 year (0 to 100%) |
(MD ‐6.17%, 95% CI ‐15.02 to 2.67) | Decompression range: 18.9 to 27.8 Usual conservative care range: 30.0 to 30.2 |
340 (2) | ⊕⊕⊝⊝ Low | |
|
Oswestry Disability Index ‐ 2 years (0 to 100%) |
(MD ‐4.43%, 95% CI ‐7.91 to ‐0.96) | Decompression range: 21.2 to 26.3 Usual conservative care range: 29 to 29.8 |
315 (2) | ⊕⊕⊝⊝ Low | |
|
Pain ‐ 3 months (0 to 10) |
(RR 1.38, 95% CI 0.22 to 8.59) | Decompression: 5.45 Usual conservative care: 2.81 |
31 (1) | ⊕⊕⊝⊝ Low | |
|
Pain ‐ 4 years (0 to 10) |
(RR 7.50, 95% CI 1.00 to 56.48) | Decompression: 5.05 Usual conservative care: 2.72 |
30 (1) | ⊕⊕⊝⊝ Low | |
|
Pain ‐ 10 years (0 to 10) |
(RR 4.09, 95% CI 0.95 to 17.58) | Decompression: 4.87 Usual conservative care: 2.74 |
29 (1) | ⊕⊕⊝⊝ Low | |
| CI: confidence interval; MD: mean difference; RR: risk ratio 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 | |||||
Studies failed on 3 of 5 GRADE factors, including:
- bias: All but 1 study had high bias risk;
- design: All but 1 study were not blinded; and
- imprecision: Only 1 study presented compete outcome data.