***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND OBJECTIVE To develop a checklist of items measuring the quality of reports of r and omized clinical trials ( RCTs ) assessing nonpharmacological treatments ( NPTs ) . STUDY DESIGN AND SETTING The Delphi consensus method was used to select and reduce the number of items in the checklist . A total of 154 individuals were invited to participate : epidemiologists and statisticians involved in the field of methodology of RCTs ( n = 55 ) , members of the Cochrane Collaboration ( n = 41 ) , and clinicians involved in planning NPT clinical trials ( n = 58 ) . Participants ranked on a 10-point Likert scale whether an item should be included in the checklist . RESULTS Fifty-five experts ( 36 % ) participated in the survey . They were experienced in systematic review s ( 68 % were involved in the Cochrane Collaboration ) and in planning RCTs ( 76 % ) . Three rounds of the Delphi method were conducted to achieve consensus . The final checklist contains 10 items and 5 subitems , with items related to the st and ardization of the intervention , care provider influence , and additional measures to minimize the potential bias from lack of blinding of participants , care providers , and outcome assessors . CONCLUSIONS This tool can be used to critically appraise the medical literature , design NPT studies , and assess the quality of trial reports included in systematic review Study Design . Prospect i ve , r and omized controlled study . Objective . To compare the functional outcomes and extent of paraspinal muscle damage between 2 decompressive techniques for lumbar canal stenosis . Summary of Background Data . Lumbar spinous process splitting decompression ( LSPSD ) preserves the muscular and liga-mentous attachments of the posterior elements of the spine . It can potentially avoid problems such as paraspinal muscle atrophy and trunk extensor weakness that can occur after conventional midline decompression . However , large series prospect i ve r and omized controlled studies are lacking . Methods . Patients with lumbar canal stenosis were r and omly allocated into 2 groups :  LSPSD ( 28 patients ) and conventional midline decompression ( 23 patients ) . The differences in operative time , blood loss , time to comfortable mobilization , and hospital stay were studied . Paraspinal muscle damage was assessed by postoperative rise in creatine phosphokinase and C-reactive protein levels . Functional outcome was evaluated at 1 year by Japanese Orthopaedic Association score , neurogenic claudication outcome score , and visual analogue scale for back pain and neurogenic claudication . Results . Fifty-one patients of mean age 56 years were followed-up for a mean 14.2 ± 2.9 months . There were no significant differences in the operative time , blood loss , and hospital stay . Both the groups showed significant improvement in the functional outcome scores at 1 year . Between the 2 groups , the Japanese Orthopaedic Association score , neurogenic claudication outcome score improvement , visual analogue scale for back pain , neurogenic claudication visual analogue scale , and the postoperative changes in serum C-reactive protein and creatine phosphokinase levels did not show any statistically significant difference . On the basis of the Japanese Orthopaedic Association recovery rate , it was found that 73.9 % of conventional midline decompression group had good outcomes compared with only 60.7 % after LSPSD . Conclusion . The functional outcome scores , back pain , and claudication pain in the immediate period and at the end of 1 year are similar in both the techniques . More patients had better functional outcomes after conventional decompression than the LSPSD technique . On the basis of this study , the superiority of one technique compared with the other is not established , m and ating the need for further long-term studies . Level of Evidence : Study Design . A prospect i ve clinical study of M-ULBD of lumbar spinal stenosis ( LSS ) . Objective . In this article , the authors describe the technique of M-ULBD for lumbar spinal stenosis , and reported 2-year follow-up results . Summary of Background Data . Recent reports showed that atrophy of multifidus muscles and chronic low back pain after conventional laminectomy may relate to disturbance of the arterial supply caused by long duration of muscle retraction , extensive muscle stripping , and damage to the dorsal rami of the posterior branches . Methods . A total of 56 patients with LSS were r and omly divided into group A and B. The 27 patients in group A ( 15 males and 12 females ) underwent M-ULBD . The other 29 patients in group B ( 18 males and 11 females ) received conventional laminectomy . Japanese Orthopaedic Association score of low back pain , 10-cm visual analogue scale , creatine phosphokinase 3 days after operation , pre- and postoperative cross-sectional areas of multifidus were used to evaluate the clinical results . Results . There was no significant difference in preoperative data between both groups . A total of 54 patients ( 27 in each group A and B ) completed 2 years of follow-up . The postoperative Japanese Orthopaedic Association and visual analogue scale scores in both groups were improved significantly compared with the corresponding preoperative ones ( P < 0.05 ) . The postoperative creatine phosphokinase , visual analogue scale score of low back pain , and atrophy rate of multifidus CSA in group A are lower than those in group B ( P < 0.05 ) . Dural tear at the contralateral side occurred in 3 cases ( 11.1 % ) in group A and 1 case in group B ( 3.4 % ) . Conclusion . Our 2 years of follow-up shows that this method is efficient for lumbar spinal stenosis treatment ; however , it still needs long-term follow-up and needs to be compared with other modified methods . Level of Evidence : Abstract Study design Prospect i ve clinical observational study of low back pain ( LBP ) in patients undergoing laminectomy or laminotomy surgery for lumbar spinal stenosis ( LSS ) . Objectives To quantify any change in LBP following laminectomy or laminotomy spinal decompression surgery . Patients and methods 119 patients with LSS completed Oswestry Disability Index question naire ( ODI ) and Visual Analogue Scale for back and leg pain , preoperatively , 6 weeks and 1 year postoperatively . Results There was significant ( p < 0.0001 ) reduction in mean LBP from a baseline of 5.14/10 to 3.03/10 at 6 weeks . Similar results were seen at 1 year where mean LBP score was 3.07/10 . There was a significant ( p < 0.0001 ) reduction in the mean ODI at 6 weeks and 1 year postoperatively . Mean ODI fell from 44.82 to 25.13 at 6 weeks and 28.39 at 1 year . Conclusion The aim of surgery in patients with LSS is to improve the result ing symptoms that include radicular leg pain and claudication . This observational study reports statistically significant improvement of LBP after LSS surgery . This provides frequency distribution data , which can be used to inform prospect i ve patients of the expected outcomes of such surgery Study Design . A prospect i ve study to evaluate the outcomes of 2 different decompressive techniques for lumbar spinal stenosis . Objective . To explore a more effective and less invasive decompression technique without instrument and fusion for lumbar spinal stenosis . Summary of Background Data . The traditional surgical decompression of spinal stenosis involves laminectomy or unilateral laminotomy . Even in unilateral laminotomy cases , 85.3 % had an excellent-to-fair operative result , and the incidence of complications was 9.8 % . Although the addition of instrumentation does not increase the complication rate , but compared to the efficiency , the higher costs was controversial . Minimal invasion and destabilization are recommended . Methods . This prospect i ve study included 152 consecutive patients , sequentially divided into 2 groups ,  underwent Windows technique  ( group A ) and decompressive laminectomy ( group B ) by 2 groups of surgeons . Results . The evaluation of the back pain , leg pain , walking tolerance , and neurologic recovery were performed before surgery and after surgery . In group A , at the final evaluation , the overall results were good to excellent in 89 % ( 68/76 ) of the patients , fair 11 % ( 8/76 ) , and poor 0 % . In group B , at the final evaluation , the overall results were good to excellent in 63 % ( 48/76 ) of the patients , fair 30 % ( 23/76 ) , and poor 7 % ( 5/76 ) . Conclusion . Degenerative spinal stenosis can be decompressed adequately with preserving the posterior elements . The “ Windows technique ” laminoforaminotomy , which obtained satisfactory long-term outcomes with few complications and low cost , can be a st and ard procedure for the surgical treatment of the degenerative spinal stenosis even with slight congenital spinal stenosis Introduction This observational study is design ed to test the equivalence between the clinical effectiveness of microdecompression and laminectomy in the surgical treatment of central lumbar spinal stenosis . Lumbar spinal stenosis is the most frequent indication for spinal surgery in the elderly , and as the oldest segment of the population continues to grow its prevalence is likely to increase . However , data on surgical outcomes are limited . Open or wide decompressive laminectomy , often combined with medial facetectomy and foraminotomy , was formerly the st and ard treatment . In recent years a growing tendency towards less invasive decompressive procedures has emerged . At present , many spine surgeons perform microdecompression for central lumbar spinal stenosis . Methods and analysis Prospect ively registered treatment and outcome data are obtained from the Norwegian Registry for Spine Surgery . The primary outcome measure is change in Oswestry disability index between baseline and 12-month follow-up . Secondary outcome measures are changes in health-related quality of life measured by the Euro-Qol-5D between baseline and 12-month follow-up , perioperative complications , and duration of surgical procedures and length of hospital stay . Ethics and dissemination The study has been evaluated and approved by the regional committee for medical research in central Norway and all participants provided written informed consent . The findings of this study will be disseminated through peer- review ed publications . Trial registration number Clinical trials.gov ( NCT02006901 ) Study Design The 2 groups of patients with severe lumbar spinal stenosis were prospect ively compared as a case control study . Objectives This prospect i ve case control study sought to evaluate bilateral microdecompressive laminatomy ( MDL ) for treatment of severe lumbar spinal stenosis . Summary of Background Data Total laminectomy is a general consensus on the therapy of severe spinal stenosis . The authors tried to investigate a new minimal invasive approach . Methods Patients were r and omly divided into 2 groups . In first group , 34 patients underwent total laminectomy ( TL ) for severe lumbar spinal stenosis . In the second group , 37 patients with the same diagnosis underwent bilateral MDL .  The groups were compared for disability , walking distance , degree of postoperative back and leg pain , perioperative complications , and postoperative instability . Radiographic analyses were performed at regular intervals to demonstrate satisfactory decompression . Results Mean follow-up was 5 years . Postoperative computerized tomography and magnetic resonance imaging demonstrated adequate decompressions in both groups . The walking distance , pain control , and disability scores were slightly higher among patients in the MDL group , although these results did not achieve statistical significance . Perioperative complications and postoperative instability were significantly higher in the TL group ( P<0.05 ) . Conclusions Compared with classic approaches , bilateral MDL provides adequate and safe decompression in lumbar spinal stenosis . It significantly reduces clinical symptoms and disability . However , TL shows higher perioperative complications and postoperative instability . To the best of our knowledge , this is the first study to define a bilateral MDL approach to treat the stenotic lumbar spine without a herniated disc STUDY DESIGN A technique for  lumbar decompression using spinous process osteotomies is described , and the outcomes are studied prospect ively . OBJECTIVE To describe a technique that affords a wide exposure for decompression while minimizing damage to surrounding tissues , and to analyze the outcomes formally using the technique . SUMMARY OF BACKGROUND DATA Commonly used techniques of lumbar decompression , which include bilateral takedown of paraspinal musculature and aggressive bony resection , can result in significant iatrogenic sequelae , whereas minimally invasive techniques often provide inadequate visualization and /or decompression . METHOD Unilateral limited takedown of the multifidus is undertaken , followed by spinous process osteotomies at the involved levels . The spinous processes with the attached interspinous/supraspinous ligaments are then retracted . A complete " trumpeted " decompression is then undertaken . Fifty consecutive patients undergoing the procedure were analyzed prospect ively and at follow-up by an independent observer using a vali date d functional outcome measure , a visual analog pain scale , and a patient satisfaction score . RESULTS Functional outcome scores improved on average by 47 % , pain levels were reduced by 66 % , and high satisfaction rates were reported by 83 % of patients . CONCLUSIONS The technique affords excellent visualization and a wide area available for Kerrison use and angulation while minimizing destruction to tissues not directly involved in the pathologic process , including the paraspinal musculature as well as the interspinous/supraspinous ligament complex and facets . Additionally , it minimizes dead space and improves the cosmetic result We assigned 67 patients with central lumbar stenosis alternately to either multiple laminotomy or total laminectomy . The protocol , however , allowed multiple laminotomy to be changed to total laminectomy if it was thought that the former procedure might not give adequate neural 
    Output:
    
Evidence of low or very low quality suggests that different techniques of posterior decompression and conventional laminectomy have similar effects on functional disability and leg pain .
We found no evidence to show that the incidence of complications , length of the procedure , length of hospital stay and postoperative walking distance differed between techniques of posterior decompression .