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Table 1 Summary of evidence graded using the GRADE approach for the included RCTs

From: Pedicle screw fixation of thoracolumbar fractures: conventional short segment versus short segment with intermediate screws at the fracture level—a systematic review and meta-analysis

Summary of findings
The use of the 6-screw construct compared to the 4-screw construct for patients with thoracolumbar fractures
Population: Patients with thoracolumbar fractures
Intervention: 6-screw construct
Comparison: 4-screw construct
Outcomes Anticipated absolute effects (95% CI) Relative effect (95% CI) Number of participants (studies) Quality of the evidence (GRADE)
Risk with 4-screw construct Risk with 6-screw construct
Operation time assessed with (min) The mean operation time was 92.8 min MD 3.88 longer [0.89, 8.65]   748 (12 studies) ⨁⨁⨁〇
Moderateb
Intraoperative blood loss assessed with (mL) The mean intraoperative blood loss was 280.3 mL MD 28.29 higher [5.97, 50.61]   808 (13 studies) ⨁⨁⨁〇
Moderateb
Hospital length of stay assessed with (days) The mean hospital length of stay was 9.6 days MD 0.35 longer [− 1.36, 2.07] 186 (3 studies) ⨁⨁〇〇
Lowa,b
VAS The mean VAS was 2.77 MD 0.87 lower [− 1.46, − 0.28] 388 (7 studies) ⨁⨁〇〇
Lowa,b
ODI The mean ODI was 18.8 MD 0.97 lower [− 2.46, 0.53] 160 (3 studies) ⨁⨁⨁〇
Moderatea
Short-term post-operative Cobb angle in degrees The mean short-term post-operative Cobb angle was 5.18 degrees MD 1.02 lower [− 2.46, 0.53] 607 (11 studies) ⨁⨁⨁〇
Moderateb
Long-term post-operative Cobb angle in degrees The mean long-term post-operative Cobb angle was 11.16 degrees MD 3.76 lower [− 5.69, − 1.82] 692 (11 studies) ⨁⨁⨁〇
Moderateb
Correction loss of Cobb angle in degrees The mean correction loss of Cobb angle was 4.22 degrees MD 1.78 lower [− 3.4, − 0.15] 254 (5 studies) ⨁⨁⨁〇
Moderateb
Correction loss of AVBH in degrees The mean correction loss of AVBH was 8.84 degrees MD 6.01 lower [− 7.66, − 4.36] 566 (8 studies) ⨁⨁⨁〇
Moderateb
Implant failure 75 per 1000 13 per 1000 [6, 27] OR 0.16 [0.07, 0.34] 1104 (16 studies) ⨁⨁⨁〇
Moderatec
Post-operative infection 23 per 1000 17 per 1000) [5, 57] OR 0.74 [0.21, 2.55] 506 (9 studies) ⨁⨁〇〇
Lowa,c
  1. CI confidence interval, OR odds ratio, MD mean difference, AVBH anterior vertebral body height, VAS visual analogue scale, ODI oswestry disability index, RCTs randomized controlled trials
  2. GRADE working group grades of evidence
  3. High quality: We are very confident that the true effect lies close to that of the estimate of the effect
  4. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
  5. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
  6. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
  7. aRisk of bias: subjective outcome and no blinding of participants/study personnel, bInconsistency: large variations in effect, large I2, cImprecision: low rate of events, large confidence intervals. No downgrading for indirectness or publication bias