Surgery
Uitgangsvraag
Key question
What is the recommended surgical technique (minimally invasive versus open) in patients with spinal metastases?
Aanbeveling
Recommendations
- Consider percutaneous vertebroplasty or kyphoplasty as a pain-relieving treatment in patients with painful vertebral metastases. See module Pain management for the indication protocol.
- Consider, following an multidisciplinary team meeting (MDO in Dutch) with the relevant organ specialist and taking into account the patient’s wishes, proceeding to surgical intervention:
- Decide between minimally invasive or open surgery based on the surgeon’s training, experience, and preference.
- Consider choosing a minimally invasive procedure for a frail patient (pre-existing KPS < 50), as this is likely to be better tolerated.
- Consider percutaneous fixation in cases of severe mechanical pain, also when an expected life expectancy is 6–12 weeks.
Overwegingen
Considerations
Balance between desired and undesired effects
Patients experiencing pain due to a mechanically unstable vertebra do not benefit from radiotherapy alone. Radiotherapy does not have a direct positive effect on the stability of the affected vertebra. In such cases, a stabilizing intervention (vertebroplasty, surgery or halo frame) is indicated. The type of surgery (open or minimally invasive) depends on the preference of the surgeon and the standard of care at the treating center, although there is a preference for the least invasive procedure possible (Amelink, 2025). In cases of mechanical pain, it is worth considering minimally invasive stabilization, even in patients with a poor life expectancy (6–12 weeks; Dea, 2020). This should be discussed in a multidisciplinary team meeting (MDO in Dutch). Please also see module Multidisciplinary consultation (MDO).
Quality of Evidence
Minimal invasive versus open procedure
The overall quality of evidence is very low. This means we are highly uncertain about the estimated effect on the crucial outcomes.
The evidence has been downgraded due to serious:
- Risk of Bias: Methodological limitations, due to lack of blinding.
- Imprecision: Inaccuracy, due to not achieving the optimal sample size.
Percutaneous vertebroplasty
The overall quality of evidence, as assessed by the National Health Care Institute (Zorginstituut Nederland), is low to moderate, based on the critical outcome measures of short-term pain reduction, serious peri- and post-procedural complications, overall quality of life, and physical functioning. The evidence was downgraded due to serious risk of bias and imprecision (Zorginstituut Nederland, 2025).
Values and Preferences of Patients (and, if applicable, Their Relatives/Caregivers)
The working group believes that adequate pain management and preservation of independence - especially maintenance of continence - play a major role in the palliative care trajectory of the patient. For this reason, the working group recommends considering surgical intervention, particularly when a patient with a limited life expectancy (6–12 weeks) suffers significant pain due to mechanically unstable vertebrae. The benefits and risks of the treatment and pain management plan should always be clearly communicated to the patient (and/or caregivers), and the patient’s preferences should be taken into account.
Cost Considerations
The working group cannot make any statements regarding the costs of either intervention. No cost-effectiveness studies have been conducted on this topic.
Equity (Health Equity/Equitable)
The intervention does not lead to an increase or decrease in health equity. Both minimal invasive surgery and open procedures are covered by health insurance.
Acceptability
Ethical acceptability
According to the working group, ethical acceptability does not play a role in this choice.
Sustainability
Most centers use reusable sets; any impact on sustainability primarily comes from packaging materials, which is comparable for both procedures.
Feasibility
Surgery, when indicated, is already standard practice. The working group foresees no barriers to feasibility.
Onderbouwing
Background
In the recent years, minimally invasive surgery has become an increasingly valuable option as a surgical procedure for patients with spinal metastases The current perception and frequency of use of more invasive procedures, such as open surgery, remain unclear. Within this module, it is essential to evaluate the added value of minimally invasive techniques compared to open procedures for this patient group. In addition, recently the Dutch National Health Care Institute (ZorgInstituut Nederland) evaluated the current state of science and clinical practice for percutaneous vertebroplasty and kyphoplasty as an alternative for fixation in painful vertebral metastases which are not considered to have an indication for surgical stabilisation (National Health Care Institute, 2025). These treatments, whether or not combined with thermal ablation or radiotherapy, have been used in the past, but from 2011 onwards were not considered standard of care and not covered by health insurance. This resulted in a dramatic decrease in the use of these techniques, which is expected to change given the positive ruling in 2025. The working group also evaluate the effect of these percutaneous techniques in this module.
Summary of Findings
Minimally invasive stabilization compared to open procedure for patients with vertebral metastases
Population: Patients with vertebral metastases for whom surgery is indicated (including patients with neurological deficits)
Intervention: Minimally invasive stabilization
Comparator: Open procedure
|
Outcome
|
Study results and measurements |
Absolute effect estimates |
Certainty of the Evidence (Quality of evidence) |
Conclusions |
|
|
Open procedure |
Minimally access spine surgery |
||||
|
Return to daily life (critical) |
- |
- |
- |
No GRADE (no evidence was found)
|
No evidence was found regarding the effect of minimally invasive stabilization when compared with open procedure in patients with vertebral metastases |
|
Neurological status (critical) |
- |
- |
- |
No GRADE (no evidence was found)
|
No evidence was found regarding the effect of minimally invasive stabilization when compared with open procedure in patients with vertebral metastases |
|
Complications (critical) |
Measured by total number of complications (infections and instrumentation failures). |
Morgen (2020) reported a complication rate of 2/23 (9%) in the open procedure group and 2/27 (7%) in the minimally access spine surgery group. |
Very low Due to risk of bias, due to very serious imprecision1 |
The evidence is very uncertain about the effect of minimally invasive surgery on complications when compared with open surgery in patients with spinal metastasis.
(Morgen, 2020) |
|
|
Quality of life (important) |
-
|
- |
No GRADE (no evidence was found)
|
No evidence was found regarding the effect of minimally invasive stabilization when compared with open procedure in patients with vertebral metastases |
|
|
Patient satisfaction (important) |
- |
- |
No GRADE (no evidence was found)
|
No evidence was found regarding the effect of minimally invasive stabilization when compared with open procedure in patients with vertebral metastases |
|
1. Risk of Bias: serious, Due to lack of blinding; Imprecision: very serious. Low number of patients, optimal information size has not been achieved
Summary of literature
Description of studies
One systematic review was included in the analysis of the literature. Within this systematic review, one randomized controlled trial (RCT) was included and will be further discussed in this summary. Important study characteristics and results of this RCT are summarized in table 2. The assessment of the risk of bias is summarized in the risk of bias tables (under the tab ‘Evidence tabellen’).
Morgen (2020) conducted a non-blinded, randomized controlled, parallel-group trial within a single hospital in Denmark. Within this RCT, they compared the results of minimally access spine surgery (MASS) to open surgery (OS) in patients with metastatic spinal cord compression. Out of 53 patients invited to join the study, 50 agreed, with 27 randomized to the MASS group and 23 to the OS group; one MASS patient was later excluded due to a non-cancer diagnosis, and all remaining patients completed the study with no loss to follow-up. Complications were defined as infections and instrumentation failures that required revision surgery, along with delayed wound healing or mild infections that resulted in postponed radiotherapy or chemotherapy treatments.
Table 2. Characteristics of included studies
|
Study |
Participants |
Comparison |
Follow-up |
Outcome measures |
Comments |
Risk of bias (per outcome measure)* |
|
Morgen, 2020 |
N at baseline Intervention: 27 Control: 23
Age (mean, range) Intervention: 65.9 [49-85] Control: 67.6 [42-88]
Sex (% male) Intervention: 38 Control: 43 |
Intervention: Minimal access spine surgery (MASS) Control: Open surgery (OS) |
NA
|
Complications |
Public and industry funding |
Low |
*For further details, see risk of bias table in the appendix
Results
1. Return to daily life (critical)
No studies reported on the effect of surgical treatment on return to daily life in patients with vertebral metastases.
2. Neurological status (critical)
No studies reported on the effect of surgical treatment on neurological status in patients vertebral metastases.
3. Complications (critical)
Morgen (2020) reported complications in the minimally access spine surgery (MASS) group (n=23) and in the open surgery (OS) group (n=27). The complication rate in the MASS group was 2 out of 23 (9%) and 2 out of 27 (7%) in the OS group (risk difference 0.01 [-0.14, 0.16]; risk ratio 1.17 (0.18, 7.69). In the OS group, one was due to instrumentation failure and another due to incorrect instrumentation level during the first surgery. In the MASS group, one patient required reoperation for a deep infection and another for instrumentation failure; no other patients experienced delayed wound healing or mild infections that postponed further treatment.
4. Quality of life (important)
No studies reported on the effect of surgical treatment on quality of life in patients with vertebral metastases.
5. Patient satisfaction (important)
No studies reported on the effect of surgical treatment on patient satisfaction in patients with vertebral metastases.
Search and select
A systematic review of the literature was performed to answer the following question(s):
What is the effectiveness and safety of minimally invasive stabilization or decompression (or a combination of both) compared to more open techniques (corpectomy, piece-meal vertebral method, or open spondylodesis) in patients with vertebral metastases?
Table 1. PICO
| Patients | Patients with vertebral metastases for whom surgery is indicated (including patients with neurological deficits) |
| Intervention | Minimally invasive stabilization |
| Control | Open procedure |
| Outcomes | Quality of life, patient satisfaction, return to daily life, neurological status, complications |
| Other selection criteria | Study design: systematic reviews and randomized controlled trials |
Relevant outcome measures
The guideline panel considered return to daily life, neurological status, and complications as a critical outcome measure for decision making; and quality of life and patient satisfaction as an important outcome measure for decision making.
A priori, the guideline panel did not define the outcome measures listed above but used the definitions used in the studies.
The guideline panel defined a reduction of 25% in complications as a minimal clinically (patient) important difference.
Search and select (Methods)
The databases Medline (via OVID) and Embase (via Embase.com) were searched with relevant search terms until July 11th, 2024. The detailed search strategy is listed under the tab ‘Literature search strategy’. The systematic literature search resulted in 287 hits. Studies were selected based on the following criteria:
- Systematic review or randomized controlled trial (RCT.
- Patients with vertebral metastases undergoing surgery (minimally invasive surgery).
- Describing at least one of the relevant outcomes specified in the PICO.
Initially, 14 studies were selected based on title and abstract screening. After reading the full text, 13 studies were excluded (see the exclusion table under the tab ‘Evidence tabellen’), and 1 study was included.
- 1 - Amelink JJGJ, van Munster BT, Bindels BJJ, Pierik RJB, van Tiel J, Groot OQ, Kasperts N, Tobert DG, Verlaan JJ. Surgical management of spinal metastases: A cross-continental study in the United States and the Netherlands. J Bone Oncol. 2025 Mar 25;52:100676. doi: 10.1016/j.jbo.2025.100676. PMID: 40230617; PMCID: PMC11994354.
- 2 - Dea N, Versteeg AL, Sahgal A, Verlaan JJ, Charest-Morin R, Rhines LD, Sciubba DM, Schuster JM, Weber MH, Lazary A, Fehlings MG, Clarke MJ, Arnold PM, Boriani S, Bettegowda C, Laufer I, Gokaslan ZL, Fisher CG. Metastatic Spine Disease: Should Patients With Short Life Expectancy Be Denied Surgical Care? An International Retrospective Cohort Study. Neurosurgery. 2020 Aug 1;87(2):303-311. doi: 10.1093/neuros/nyz472. PMID: 31690935; PMCID: PMC7360875.
- 3 - Hinojosa-Gonzalez DE, Roblesgil-Medrano A, Villarreal-Espinosa JB, Tellez-Garcia E, Bueno-Gutierrez LC, Rodriguez-Barreda JR, Flores-Villalba E, Martinez HR, Benvenutti-Regato M, Figueroa-Sanchez JA. Minimally Invasive versus Open Surgery for Spinal Metastasis: A Systematic Review and Meta-Analysis. Asian Spine J. 2022 Aug;16(4):583-597. doi: 10.31616/asj.2020.0637. Epub 2021 Sep 1. PMID: 34465015; PMCID: PMC9441425.
- 4 - Morgen SS, Hansen LV, Karbo T, Svardal-Stelmer R, Gehrchen M, Dahl B. Minimal Access vs. Open Spine Surgery in Patients With Metastatic Spinal Cord Compression - A One-Center Randomized Controlled Trial. Anticancer Res. 2020 Oct;40(10):5673-5678. doi: 10.21873/anticanres.114581. PMID: 32988892.
- 5 - National Health Care Institute (Zorginstituut Nederland). Standpunt Vertebroplastiek of ballonkyphoplastiek bij patiënten met pijnlijke vertebrale compressiefracturen ten gevolge van wervelmetastasten of wervellokalisaties van multipel myeloom. https://www.zorginstituutnederland.nl/werkagenda/kanker/standpunt-vertebroplastiek-bij-pijnlijke-werveluitzaaiingen-of-wervellokalisaties-van-multipel-myeloom Assessed 10 Nov 2025.
Evidence tables
Risk of bias table for intervention studies (randomized controlled trials; based on Cochrane risk of bias tool and suggestions by the CLARITY Group at McMaster University)
|
Study reference
(first author, publication year) |
Was the allocation sequence adequately generated? |
Was the allocation adequately concealed? |
Blinding: Was knowledge of the allocated interventions adequately prevented? Were patients/healthcare providers/data collectors/outcome assessors/data analysts blinded? |
Was loss to follow-up (missing outcome data) infrequent? |
Are reports of the study free of selective outcome reporting? |
Was the study apparently free of other problems that could put it at a risk of bias? |
Overall risk of bias If applicable/necessary, per outcome measure |
|
Morgen, 2020 |
Definitely yes;
Reason: Balanced (1:1) randomization with computer-generated list of random numbers and a fixed block size of 20. |
Definitely yes;
Reason: Sealed, numbered envelopes were used and opened after agreement with the patient. |
Definitely no;
Reason: Patient, surgeon, and staff members were non-blinded (blinding of data collectors, outcome assessors and analysts not reported). |
Definitely no;
Reason: No loss to follow-up. |
Definitely yes;
Reason: All relevant outcomes were reported. |
Probably no;
Reason: Public funding during the conduct of the study, and industry funding (from Medtronic and K2M, companies in the medical device industry) outside the submitted work. |
LOW |
Table of excluded studies
|
Reference |
Reason for exclusion |
|
Alshareef M, Klapthor G, Alawieh A, Lowe S, Frankel B. Evaluation of open and minimally invasive spinal surgery for the treatment of thoracolumbar metastatic epidural spinal cord compression: a systematic review. Eur Spine J. 2021 Oct;30(10):2906-2914. doi: 10.1007/s00586-021-06880-7. Epub 2021 May 30. PMID: 34052895. |
Another systematic review is more recent. |
|
Dhamija B, Batheja D, Balain BS. A systematic review of MIS and open decompression surgery for spinal metastases in the last two decades. J Clin Orthop Trauma. 2021 Sep 25;22:101596. doi: 10.1016/j.jcot.2021.101596. PMID: 34631409; PMCID: PMC8488238. |
Systematic review with no comparison to open surgery. |
|
Health Quality Ontario. Vertebral Augmentation Involving Vertebroplasty or Kyphoplasty for Cancer-Related Vertebral Compression Fractures: A Systematic Review. Ont Health Technol Assess Ser. 2016 May 1;16(11):1-202. PMID: 27298655; PMCID: PMC4902848. |
A systematic review with the wrong study population and no comparison to open surgery. |
|
Lu VM, Alvi MA, Goyal A, Kerezoudis P, Bydon M. The Potential of Minimally Invasive Surgery to Treat Metastatic Spinal Disease versus Open Surgery: A Systematic Review and Meta-Analysis. World Neurosurg. 2018 Apr;112:e859-e868. doi: 10.1016/j.wneu.2018.01.176. Epub 2018 Feb 24. PMID: 29408300. |
Another systematic review is more recent. |
|
Pennington Z, Ahmed AK, Molina CA, Ehresman J, Laufer I, Sciubba DM. Minimally invasive versus conventional spine surgery for vertebral metastases: a systematic review of the evidence. Ann Transl Med. 2018 Mar;6(6):103. doi: 10.21037/atm.2018.01.28. PMID: 29707552; PMCID: PMC5900071. |
Another systematic review is more recent. |
|
Perna A, Smakaj A, Vitiello R, Velluto C, Proietti L, Tamburrelli FC, Maccauro G. Posterior Percutaneous Pedicle Screws Fixation Versus Open Surgical Instrumented Fusion for Thoraco-Lumbar Spinal Metastases Palliative Management: A Systematic Review and Meta-analysis. Front Oncol. 2022 Apr 4;12:884928. doi: 10.3389/fonc.2022.884928. PMID: 35444954; PMCID: PMC9013833. |
Another systematic review is more recent. |
|
Pranata R, Lim MA, Vania R, Bagus Mahadewa TG. Minimal Invasive Surgery Instrumented Fusion versus Conventional Open Surgical Instrumented Fusion for the Treatment of Spinal Metastases: A Systematic Review and Meta-analysis. World Neurosurg. 2021 Apr;148:e264-e274. doi: 10.1016/j.wneu.2020.12.130. Epub 2021 Jan 5. PMID: 33418123. |
Another systematic review is more recent. |
|
Sagoo NS, Haider AS, Ozair A, Vannabouathong C, Rahman M, Haider M, Sharma N, Raj KM, Raj SD, Paul JC, Steinmetz MP, Adogwa O, Aoun SG, Passias PG, Vira S. Percutaneous image-guided cryoablation of spinal metastases: A systematic review. J Clin Neurosci. 2022 Feb;96:120-126. doi: 10.1016/j.jocn.2021.11.008. Epub 2021 Nov 25. PMID: 34840092. |
Systematic review with no comparison to open surgery. |
|
Sagoo NS, Haider AS, Rowe SE, Haider M, Sharma R, Neeley OJ, Dahdaleh NS, Adogwa O, Bagley CA, El Ahmadieh TY, Aoun SG. Microwave Ablation as a Treatment for Spinal Metastatic Tumors: A Systematic Review. World Neurosurg. 2021 Apr;148:15-23. doi: 10.1016/j.wneu.2020.12.162. Epub 2021 Jan 8. PMID: 33422713. |
Systematic review with no comparison to open surgery. |
|
Schupper AJ, Patel S, Steinberger JM, Germano IM. The role of minimally invasive surgery within a multidisciplinary approach for patients with metastatic spine disease over a decade: A systematic review. Neuro Oncol. 2024 Mar 4;26(3):417-428. doi: 10.1093/neuonc/noad206. PMID: 37988270; PMCID: PMC10912012. |
Systematic review with no comparison to open surgery. |
|
Spiessberger A, Arvind V, Gruter B, Cho SK. Thoracolumbar corpectomy/spondylectomy for spinal metastasis: a pooled analysis comparing the outcome of seven different surgical approaches. Eur Spine J. 2020 Feb;29(2):248-256. doi: 10.1007/s00586-019-06179-8. Epub 2019 Oct 22. PMID: 31641907. |
Another systematic review is more recent. |
|
Yang Z, Yang Y, Zhang Y, Zhang Z, Chen Y, Shen Y, Han L, Xu D, Sun H. Minimal access versus open spinal surgery in treating painful spine metastasis: a systematic review. World J Surg Oncol. 2015 Feb 21;13:68. doi: 10.1186/s12957-015-0468-y. PMID: 25880538; PMCID: PMC4342220. |
Another systematic review is more recent. |
|
Zuckerman SL, Laufer I, Sahgal A, Yamada YJ, Schmidt MH, Chou D, Shin JH, Kumar N, Sciubba DM. When Less Is More: The indications for MIS Techniques and Separation Surgery in Metastatic Spine Disease. Spine (Phila Pa 1976). 2016 Oct 15;41 Suppl 20(Suppl 20):S246-S253. doi: 10.1097/BRS.0000000000001824. PMID: 27753784; PMCID: PMC5551976. |
Systematic review with no comparison to open surgery. |
Beoordelingsdatum en geldigheid
Publicatiedatum : 05-06-2026
Beoordeeld op geldigheid : 05-06-2026
Algemene gegevens
De ontwikkeling/herziening van deze richtlijnmodule werd ondersteund door het Kennisinstituut van de Federatie Medisch Specialisten (www.demedischspecialist.nl/kennisinstituut) en werd gefinancierd door de Stichting Kwaliteitsgelden Medisch Specialisten (SKMS). De financier heeft geen enkele invloed gehad op de inhoud van de richtlijnmodule.
Samenstelling werkgroep
Voor het ontwikkelen van de richtlijnmodule is in 2023 een multidisciplinaire werkgroep ingesteld, bestaande uit vertegenwoordigers van alle relevante specialismen (zie hiervoor de Samenstelling van de werkgroep) die betrokken zijn bij de zorg voor patiënten met wervelmetastasen.
Werkgroep
- dr. W. (Walter) Taal (voorzitter), neuroloog Erasmuc MC, Nederlandse Vereniging voor Neurologie
- drs. L. (Lena) van Iterson, AIOS-neuroloog Elisabeth-TweeSteden Ziekenhuis, Nederlandse Vereniging voor Neurologie
- drs. R.P.B. (Robin) Boltjes, neuroloog Antoni van Leeuwenhoek Ziekenhuis, Nederlandse Vereniging voor Neurologie
- Prof. dr. JJ. (Jorrit-Jan) Verlaan, Orthopedisch chirurg UMC Utrecht, Nederlandse Orthopaedische Vereniging
- dr. J. (Jasper) van Tiel, Orthopedisch chirurg UMC Utrecht, Nederlandse Orthopaedische Vereniging
- dr. V. (Vivian) Bongers, Nucleaire geneeskunde Diakonessenhuis Utretch, Nederlandse Vereniging voor Nucleaire Geneeskunde
- Prof. dr. R. (Ronald) Bartels, Neurochirurg Radboudumc, Nederlandse Vereniging voor Neurochirurgie
- dr. S.O. (Selma) Algra, Radioloog UMC Utrecht, Nederlandse Vereniging voor Radiologie
- drs. M.G.A. (Maaike) Schippers, radiotherapeut Instituut Verbeeten, Nederlandse Vereniging voor Radiotherapie en Oncologie
- dr. J.M. (Joanne) van der Velden, radiotherapeut UMC Utrecht, Nederlandse Vereniging voor Radiotherapie en Oncologie
- dr. M.S. (Marthe) Paats, longarts Erasmus MC, Nederlandse Vereniging voor Artsen voor Longziekten en TBC
- dr. P.F. (Paula) Ypma, Internist hematoloog Haga Ziekenhuis, Nederlandse Internisten Vereniging
- dr. F.Y.F.L. (Filip) de Vos, internist-oncoloog en kaderarts palliatieve zorg UMC Utrecht, Nederlandse Internisten Vereniging
- dr. M. (Marije) Vos- van der Hulst, revalidatiearts Sint Maartenskliniek, Nederlandse Vereniging van Revalidatieartsen (vanaf oktober 2025)
- Mevr. S (Silvie) Dronkers†, patiëntvertegenwoordiger, Stichting Darmkanker (tot oktober 2025)
- dr. T.A.R. (Tebbe) Sluis†, Revalidatiearts Rijndam, Nederlandse Vereniging van Revalidatieartsen (tot mei 2025)
Klankbordgroep
- Mevr. Manon Immerzeel, Verpleegkundig specialist Reinier de Graaf ziekenhuis, Verpleegkundigen en Verzorgenden Nederland
- drs. A. (Anita) Ophof, anesthesioloog Antoni van Leeuwenhoek Ziekenhuis, Nederlandse Vereniging voor Anesthesiologie
Met dank aan
- dr. J.H. (Jurgen) Runge, interventieradioloog, UMC Groningen, Nederlandse Vereniging voor Radiologie
Met ondersteuning van
- dr. J. (Josefien) Buddeke, senior adviseur, Kennisinstituut van de Federatie Medisch Specialisten (vanaf juli 2024)
- dr. L. (Linda) Oostendorp, senior adviseur, Kennisinstituut van de Federatie Medisch Specialisten (tot juli 2024)
- drs. B. (Beatrix) Vogelaar, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- dr. J. (Jing) de Haan-Du, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- drs. D. (Danique) Middelhuis, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- drs. A. (Alies) Oost, informatiespecialist, Kennisinstituut van de Federatie Medisch Specialisten
Belangenverklaringen
Een overzicht van de belangen van werkgroepleden en het oordeel over het omgaan met eventuele belangen vindt u in onderstaande tabel. De ondertekende belangenverklaringen zijn op te vragen bij het secretariaat van het Kennisinstituut van de Federatie Medisch Specialisten via secretariaat@kennisinstituut.nl.
Gemelde (neven)functies en belangen werkgroep
|
Naam WERKGROEP |
Hoofdfunctie |
Nevenwerkzaamheden |
Persoonlijke Financiele_Belangen |
Persoonlijke Relaties |
Extern Gefinancierd Onderzoek |
Intellectuele Belangen Reputatie |
Overige Belangen |
Datum |
Acties |
|
Jasper van Tiel |
Orthopedisch chirurg UMC Utrecht en Acibadem IMC |
geen |
geen |
geen |
geen |
geen |
geen |
22-11-2023 |
Geen restrictie |
|
Joanne van der Velden |
Radiotherapeut bij het UMC Utrecht, betaald |
Bestuurslid bij het Landelijk Platform Palliatieve Radiotherapie (NVRO), onbetaald |
Geen |
Geen |
Deelname aan 2 extern gefinancierde onderzoeken, zie onder |
Verwerven van erkenning speelt mee aan mijn deelname aan de werkgroep richtlijn Wervelmetastasen |
Geen overige belangen |
28-12-2023 |
Geen restrictie |
|
Jorrit-Jan Verlaan |
Orthopedisch chirurg, UMC Utrecht (0.4 Fte) |
Lid steering committee AO Spine Knowledge Forum Tumor (onbetaald maar met onkosten vergoeding). |
Hoe de richtlijn wordt vormgegeven staat los van mijn persoonlijke financiële belangen. Er zijn ook geen belangen voor SentryX hoe de richtlijn wordt vormgegeven. |
geen |
Ja. |
Ik heb nationale/internationale expertise/reputatie en een leerstoel op het gebied van de behandeling van wervelmetastasen. Een goed uitgevoerde richtlijn kan helpen deze expertise/reputatie meer exposure te geven maar de impact en eventuele belangenverstrengeling zijn mij onduidelijk. |
geen |
22-11-2023 |
Geen restrictie. Geen penvoerder bij module 'Inschatten overleving'. |
|
Filip de Vos |
Internist-oncoloog en kaderarts palliatieve zorg |
geen |
geen |
geen |
ja |
geen |
BMS Advisory Board; Faculty member ESMO CNS tumors; Quality of Care commission Dutch Society of Medical Oncology; |
20-12-2023 |
Geen restrictie. (In de richtlijn worden geen systemische therapien aanbevolen.) |
|
Maaike Schippers |
Radiotherapeut |
geen |
geen |
geen |
geen |
geen |
geen |
3-12-2023 |
Geen restrictie |
|
Marthe Paats |
Longarts Erasmus MC |
geen |
Geen relevant voor huidige richtlijn. |
geen |
industrie gesponsorde studies lopend in het Erasmus MC waarbij ik lokale PI ben. |
geen |
geen |
26-02-2024 |
Geen restrictie. In de richtlijn worden geen systemische therapien aanbevolen. |
|
Robin Boltjes |
Neuroloog in Antoni van Leeuwenhoek/NKI |
geen |
geen |
nee |
geen |
geen |
nee |
22-11-2023 |
Geen restrictie |
|
Ronald Bartels |
Neurochirurg |
Medisch Adviseur |
geen |
nee |
geen |
net |
geen |
03-04-2024 |
Restrictie ten aanzien van besluitvorming betreffende 'Inschatten overleving'. Vanuit expertise wel meegediscussierd over inhoud van de module, niet betrokken bij het formuleren van de aanbevelingen. |
|
Tebbe Sluis |
revalidatiearts |
geen |
geen |
geen |
geen |
geen |
geen |
11-12-2023 |
Geen restrictie |
|
Vivian Bongers |
MSB Domstad, medisch specialist |
Uitgeverij Prelum, Redacteur tijdschrift IMAGO |
Geen |
Geen |
Geen |
Geen |
Geen |
23-11-2023 |
Geen restrictie |
|
Ypma |
internist hematoloog Hagaziekenhuis den Haag |
geen |
geen |
geen |
Alphabet trial |
geen |
nvt |
04-05-2024 |
Geen restrictie |
|
Van Iterson |
AIOS neurologie |
geen |
geen |
geen |
geen |
geen |
geen |
25-04-2024 |
Geen restrictie |
|
Selma Algra |
Radioloog,St Jansdal Ziekenhuis |
geen |
geen |
geen |
geen |
geen |
geen |
03-09-2024 |
Geen resctrictie |
|
Silvie Dronkers |
Stichting Darmkanker |
geen |
geen |
geen |
geen |
geen |
geen |
06-02-2025 |
Geen restrictie |
|
Walter Taal (voorzitter) |
Neuroloog, Erasmus MC, Rotterdam |
Geen |
Geen |
Geen |
Ja. Alleen op het gebied van neurofibromatose type 1 |
Geen |
Geen |
07-06-2023 |
Geen restrictie |
|
Marije Vos-van der Hulst |
Revalidatie arts, Sint Maartenskliniek Nijmegen |
Voorzitter werkgroep revalidatie artsen dwarslaesie (Nederlands Vlaams dwarslaesie genootschap= werkgroep van de vereniging revalidatieartsen nederland (VRA)) |
geen |
geen |
geen |
geen |
geen |
13-10-2025 |
Geen restrictie |
|
Naam KLANKBORDGROEP |
Hoofdfunctie |
Nevenwerkzaamheden |
Persoonlijke Financiele_Belangen |
Persoonlijke Relaties |
Extern Gefinancierd Onderzoek |
Intellectuele Belangen Reputatie |
Overige Belangen |
Datum |
Acties |
|
Manon Immerzeel |
Deelnemer clusterstuurgroep |
Geen |
Geen |
Geen |
Geen |
Voorzitter in het bestuur van V&VN pijnverpleegkundigen |
Neen |
22-03-2022 |
Geen restrictie |
|
Anita Ophof |
Antoni van Leeuwenhoek Ziekenhuis |
Geen |
Geen |
Geen |
Geen |
Geen |
Geen |
01-05-2025 |
Geen restrictie |
Inbreng patiëntenperspectief
Kwalitatieve raming van mogelijke financiële gevolgen in het kader van de Wkkgz
Bij de richtlijnmodule voerde de werkgroep conform de Wet kwaliteit, klachten en geschillen zorg (Wkkgz) een kwalitatieve raming uit om te beoordelen of de aanbevelingen mogelijk leiden tot substantiële financiële gevolgen. Bij het uitvoeren van deze beoordeling is de richtlijnmodule op verschillende domeinen getoetst (zie het stroomschema bij Werkwijze).
De kwalitatieve raming is toegevoegd aan het einde van elke herziene module.
| Module | Uitkomst raming | Toelichting |
| Sugery | Geen substantiële financiële gevolgen | Hoewel uit de toetsing volgt dat de aanbevelingen breed toepasbaar zijn (5.000-40.000 patiënten), volgt ook uit de toetsing dat het geen nieuwe manier van zorgverlening of andere organisatie van zorgverlening betreft. Er worden daarom geen substantiële financiële gevolgen verwacht. |
Werkwijze
Voor meer details over de gebruikte richtlijnmethodologie verwijzen wij u naar de Werkwijze. Relevante informatie voor de ontwikkeling/herziening van deze richtlijnmodule is hieronder weergegeven.
Zoekverantwoording
Algemene informatie
|
Cluster/richtlijn: NVN Wervelmetastasen |
|
|
Uitgangsvraag/modules: UV5 Wat is de aanbevolen chirurgische techniek (percutaan/minimaal invasief versus conventioneel/open) bij patiënten met wervelmetastasen? |
|
|
Database(s): Embase.com, Ovid/Medline |
Datum: 11 juli 2024 |
|
Periode: vanaf 2014 |
Talen: geen restrictie |
|
Literatuurspecialist: Alies Oost |
Rayyan review: https://rayyan.ai/reviews/1092280 |
|
BMI-zoekblokken: voor verschillende opdrachten wordt (deels) gebruik gemaakt van de zoekblokken van BMI-Online https://blocks.bmi-online.nl/ Deduplication: voor het ontdubbelen is gebruik gemaakt van http://dedupendnote.nl/ |
|
|
Toelichting: Voor deze vraag is gezocht op de elementen:
De sleutelartikelen worden gevonden met deze search. |
|
|
Te gebruiken voor richtlijntekst: In de databases Embase.com en Ovid/Medline is op 11 juli 2024 systematisch gezocht naar systematische reviews en RCTs (en observationele studies) vanaf 2014 over minimaal invasieve chirurgie bij wervelmetastasen. De literatuurzoekactie leverde 287 unieke treffers op. |
|
Zoekopbrengst
|
|
EMBASE |
OVID/MEDLINE |
Ontdubbeld |
|
SR |
120 |
60 |
127 |
|
RCT |
137 |
63 |
160 |
|
Observationele studies |
602 |
360 |
655 |
|
Totaal |
|
|
287* |
*in Rayyan
Zoekstrategie
Embase.com
|
No. |
Query |
Results |
|
#1 |
'spine metastasis'/exp OR 'spinal cord metastasis'/exp OR 'cervical lymph node metastasis'/exp OR (('spinal cord tumor'/exp OR 'spine tumor'/exp OR 'spinal cord compression'/exp OR (((spinal* OR medulla*) NEAR/3 (compress* OR impingement OR pinch*)):ti,ab,kw)) AND ('metastasis'/de OR 'bone metastasis'/de OR metasta*:ti,ab,kw OR oligometasta*:ti,ab,kw OR micrometasta*:ti,ab,kw OR (((neoplas* OR carcinoma OR cancer* OR malignan* OR tumor* OR tumour*) NEAR/4 (dissemination OR disseminated OR spread* OR secondary OR migrat* OR seed*)):ti,ab,kw))) OR (((spine* OR spinal* OR intraspinal OR vertebr* OR 'cauda equina' OR cervicothoracic OR cord* OR coccyx OR duralsac* OR 'dural sac*' OR epidural OR extradural OR 'extra dural' OR intervertebr* OR lumbar OR lumbosac* OR 'lumbo sac*' OR orthothoracic OR sacral OR sacrum OR 'thecal sac*' OR thoracolumbar OR odontoid OR 'anterior horn' OR 'posterior horn' OR 'extrapyramidal tract*' OR 'pyramidal tract*' OR 'substantia gelatinosa' OR 'spinothalamic tract*') NEAR/4 (metast* OR oligometast* OR micrometast*)):ti,ab,kw) OR ((cervical*:ti,ab,kw OR medulla*:ti,ab,kw OR intramedulla*:ti,ab,kw OR thoracic:ti,ab,kw) AND (spine*:ti,ab,kw OR spinal*:ti,ab,kw OR intraspinal:ti,ab,kw OR vertebr*:ti,ab,kw OR intervertebr*:ti,ab,kw OR lumbar:ti,ab,kw) AND (metast*:ti,ab,kw OR oligometast*:ti,ab,kw OR micrometast*:ti,ab,kw)) OR mescc:ti,ab,kw OR mscc:ti,ab,kw |
29263 |
|
#2 |
'minimally invasive surgery'/exp OR 'minimally invasive procedure'/exp OR 'thoracoscopic surgery'/exp OR 'laparoscopic surgery'/exp OR 'endoscopic surgery'/exp OR 'robot assisted surgery'/exp OR 'video assisted surgery'/exp OR thoracoscop*:ti,ab,kw OR videothoracoscop*:ti,ab,kw OR laparoscop*:ti,ab,kw OR 'mini* invasive':ti,ab,kw OR 'mini* access':ti,ab,kw OR vats:ti,ab,kw OR rats:ti,ab,kw OR robot*:ti,ab,kw OR 'video assisted':ti,ab,kw OR 'videoassisted':ti,ab,kw OR endosurg*:ti,ab,kw OR (((percutaneous OR endoscop* OR arthroscop*) NEAR/3 (surg* OR radiosurg* OR operat* OR procedure* OR fixat* OR rod OR rods OR screw*)):ti,ab,kw) OR 'vertebral augmentation'/exp OR 'vertebral augmentation':ti,ab,kw OR 'kyphoplasty'/exp OR kyphoplast*:ti,ab,kw OR 'percutaneous vertebroplasty'/exp OR vertebroplast*:ti,ab,kw OR 'ablation therapy'/exp OR 'radiofrequency ablation'/exp OR 'thermal ablation'/exp OR (((radiofrequency OR 'radio frequency' OR thermal OR thermic OR thermo OR heat OR catheter) NEAR/3 ablat*):ti,ab,kw) OR thermoablat*:ti,ab,kw OR ((ablat* NEAR/3 (method* OR procedure* OR surg* OR technique* OR therap* OR treatment*)):ti,ab,kw) OR rfa:ti,ab,kw |
2031353 |
|
#3 |
#1 AND #2 AND [2014-2024]/py NOT ('conference abstract'/it OR 'editorial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp) |
1490 |
|
#4 |
'meta analysis'/exp OR 'meta analysis (topic)'/exp OR metaanaly*:ti,ab OR 'meta analy*':ti,ab OR metanaly*:ti,ab OR 'systematic review'/de OR 'cochrane database of systematic reviews'/jt OR prisma:ti,ab OR prospero:ti,ab OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab) OR ((systemic* NEAR/1 review*):ti,ab) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab) OR (((literature NEAR/3 review*):ti,ab) AND (search*:ti,ab OR database*:ti,ab OR 'data base*':ti,ab)) OR (('data extraction':ti,ab OR 'data source*':ti,ab) AND 'study selection':ti,ab) OR ('search strategy':ti,ab AND 'selection criteria':ti,ab) OR ('data source*':ti,ab AND 'data synthesis':ti,ab) OR medline:ab OR pubmed:ab OR embase:ab OR cochrane:ab OR (((critical OR rapid) NEAR/2 (review* OR overview* OR synthes*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synthes*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynthes*:ti,ab OR 'meta synthes*':ti,ab |
1044443 |
|
#5 |
'clinical trial'/exp OR 'randomization'/exp OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'crossover procedure'/exp OR 'placebo'/exp OR 'prospective study'/exp OR rct:ab,ti OR random*:ab,ti OR 'single blind':ab,ti OR 'randomised controlled trial':ab,ti OR 'randomized controlled trial'/exp OR placebo*:ab,ti |
4067137 |
|
#6 |
'major clinical study'/de OR 'clinical study'/de OR 'case control study'/de OR 'family study'/de OR 'longitudinal study'/de OR 'retrospective study'/de OR 'prospective study'/de OR 'comparative study'/de OR 'cohort analysis'/de OR ((cohort NEAR/1 (study OR studies)):ab,ti) OR (('case control' NEAR/1 (study OR studies)):ab,ti) OR (('follow up' NEAR/1 (study OR studies)):ab,ti) OR (observational NEAR/1 (study OR studies)) OR ((epidemiologic NEAR/1 (study OR studies)):ab,ti) OR (('cross sectional' NEAR/1 (study OR studies)):ab,ti) |
8313160 |
|
#7 |
'case control study'/de OR 'comparative study'/exp OR 'control group'/de OR 'controlled study'/de OR 'controlled clinical trial'/de OR 'crossover procedure'/de OR 'double blind procedure'/de OR 'phase 2 clinical trial'/de OR 'phase 3 clinical trial'/de OR 'phase 4 clinical trial'/de OR 'pretest posttest design'/de OR 'pretest posttest control group design'/de OR 'quasi experimental study'/de OR 'single blind procedure'/de OR 'triple blind procedure'/de OR (((control OR controlled) NEAR/6 trial):ti,ab,kw) OR (((control OR controlled) NEAR/6 (study OR studies)):ti,ab,kw) OR (((control OR controlled) NEAR/1 active):ti,ab,kw) OR 'open label*':ti,ab,kw OR (((double OR two OR three OR multi OR trial) NEAR/1 (arm OR arms)):ti,ab,kw) OR ((allocat* NEAR/10 (arm OR arms)):ti,ab,kw) OR placebo*:ti,ab,kw OR 'sham-control*':ti,ab,kw OR (((single OR double OR triple OR assessor) NEAR/1 (blind* OR masked)):ti,ab,kw) OR nonrandom*:ti,ab,kw OR 'non-random*':ti,ab,kw OR 'quasi-experiment*':ti,ab,kw OR crossover:ti,ab,kw OR 'cross over':ti,ab,kw OR 'parallel group*':ti,ab,kw OR 'factorial trial':ti,ab,kw OR ((phase NEAR/5 (study OR trial)):ti,ab,kw) OR ((case* NEAR/6 (matched OR control*)):ti,ab,kw) OR ((match* NEAR/6 (pair OR pairs OR cohort* OR control* OR group* OR healthy OR age OR sex OR gender OR patient* OR subject* OR participant*)):ti,ab,kw) OR ((propensity NEAR/6 (scor* OR match*)):ti,ab,kw) OR versus:ti OR vs:ti OR compar*:ti OR ((compar* NEAR/1 study):ti,ab,kw) OR (('major clinical study'/de OR 'clinical study'/de OR 'cohort analysis'/de OR 'observational study'/de OR 'cross-sectional study'/de OR 'multicenter study'/de OR 'correlational study'/de OR 'follow up'/de OR cohort*:ti,ab,kw OR 'follow up':ti,ab,kw OR followup:ti,ab,kw OR longitudinal*:ti,ab,kw OR prospective*:ti,ab,kw OR retrospective*:ti,ab,kw OR observational*:ti,ab,kw OR 'cross sectional*':ti,ab,kw OR cross?ectional*:ti,ab,kw OR multicent*:ti,ab,kw OR 'multi-cent*':ti,ab,kw OR consecutive*:ti,ab,kw) AND (group:ti,ab,kw OR groups:ti,ab,kw OR subgroup*:ti,ab,kw OR versus:ti,ab,kw OR vs:ti,ab,kw OR compar*:ti,ab,kw OR 'odds ratio*':ab OR 'relative odds':ab OR 'risk ratio*':ab OR 'relative risk*':ab OR 'rate ratio':ab OR aor:ab OR arr:ab OR rrr:ab OR ((('or' OR 'rr') NEAR/6 ci):ab))) |
15232022 |
|
#8 |
#3 AND #4 - SR |
120 |
|
#9 |
#3 AND #5 NOT #8 - RCT |
137 |
|
#10 |
#3 AND (#6 OR #7) NOT (#8 OR #9) - observationeel |
602 |
|
#11 |
#8 OR #9 OR #10 |
859 |
Ovid/Medline
|
# |
Searches |
Results |
|
1 |
((exp Spinal Neoplasms/ or exp Spinal Cord Neoplasms/ or exp Spinal Cord Compression/ or ((spinal* or medulla*) adj3 (compress* or impingement or pinch*)).ti,ab,kf.) and (exp Neoplasm Metastasis/ or metasta*.ti,ab,kf. or oligometasta*.ti,ab,kf. or micrometasta*.ti,ab,kf. or ((neoplas* or carcinoma or cancer* or malignan* or tumor* or tumour*) adj4 (dissemination or disseminated or spread* or secondary or migrat* or seed*)).ti,ab,kf.)) or ((spine* or spinal* or intraspinal or vertebr* or 'cauda equina' or cervicothoracic or cord* or coccyx or duralsac* or 'dural sac*' or epidural or extradural or 'extra dural' or intervertebr* or lumbar or lumbosac* or 'lumbo sac*' or orthothoracic or sacral or sacrum or 'thecal sac*' or thoracolumbar or odontoid or "Anterior Horn" or "Posterior Horn" or "Extrapyramidal Tract*" or "Pyramidal Tract*" or "Substantia Gelatinosa" or "Spinothalamic Tract*") adj4 (metast* or oligometast* or micrometast*)).ti,ab,kf. or ((cervical* or medulla* or intramedulla* or thoracic) and (spine* or spinal* or intraspinal or vertebr* or intervertebr* or lumbar) and (metast* or oligometast* or micrometast*)).ti,ab,kf. or mescc.ti,ab,kf. or mscc.ti,ab,kf. |
15150 |
|
2 |
exp Minimally Invasive Surgical Procedures/ or exp Thoracoscopy/ or exp Laparoscopy/ or Endoscopy/ or exp Robotic Surgical Procedures/ or Video-Assisted Surgery/ or thoracoscop*.ti,ab,kf. or videothoracoscop*.ti,ab,kf. or laparoscop*.ti,ab,kf. or 'mini* invasive'.ti,ab,kf. or 'mini* access'.ti,ab,kf. or vats.ti,ab,kf. or rats.ti,ab,kf. or robot*.ti,ab,kf. or 'video assisted'.ti,ab,kf. or 'videoassisted'.ti,ab,kf. or endosurg*.ti,ab,kf. or ((percutaneous or endoscop* or arthroscop*) adj3 (surg* or radiosurg* or operat* or procedure* or fixat* or rod or rods or screw*)).ti,ab,kf. or 'vertebral augmentation'.ti,ab,kf. or exp Kyphoplasty/ or kyphoplast*.ti,ab,kf. or exp Vertebroplasty/ or vertebroplast*.ti,ab,kf. or Catheter Ablation/ or Radiofrequency Ablation/ or ((radiofrequency or 'radio frequency' or thermal or thermic or thermo or heat or catheter) adj3 ablat*).ti,ab,kf. or thermoablat*.ti,ab,kf. or (ablat* adj3 (method* or procedure* or surg* or technique* or therap* or treatment*)).ti,ab,kf. or rfa.ti,ab,kf. |
1841844 |
|
3 |
(1 and 2) not (comment/ or editorial/ or letter/) not ((exp animals/ or exp models, animal/) not humans/) |
1466 |
|
4 |
limit 3 to yr="2014 -Current" |
895 |
|
5 |
meta-analysis/ or meta-analysis as topic/ or (metaanaly* or meta-analy* or metanaly*).ti,ab,kf. or systematic review/ or cochrane.jw. or (prisma or prospero).ti,ab,kf. or ((systemati* or scoping or umbrella or "structured literature") adj3 (review* or overview*)).ti,ab,kf. or (systemic* adj1 review*).ti,ab,kf. or ((systemati* or literature or database* or data-base*) adj10 search*).ti,ab,kf. or ((structured or comprehensive* or systemic*) adj3 search*).ti,ab,kf. or ((literature adj3 review*) and (search* or database* or data-base*)).ti,ab,kf. or (("data extraction" or "data source*") and "study selection").ti,ab,kf. or ("search strategy" and "selection criteria").ti,ab,kf. or ("data source*" and "data synthesis").ti,ab,kf. or (medline or pubmed or embase or cochrane).ab. or ((critical or rapid) adj2 (review* or overview* or synthes*)).ti. or (((critical* or rapid*) adj3 (review* or overview* or synthes*)) and (search* or database* or data-base*)).ab. or (metasynthes* or meta-synthes*).ti,ab,kf. |
758586 |
|
6 |
exp clinical trial/ or randomized controlled trial/ or exp clinical trials as topic/ or randomized controlled trials as topic/ or Random Allocation/ or Double-Blind Method/ or Single-Blind Method/ or (clinical trial, phase i or clinical trial, phase ii or clinical trial, phase iii or clinical trial, phase iv or controlled clinical trial or randomized controlled trial or multicenter study or clinical trial).pt. or random*.ti,ab. or (clinic* adj trial*).tw. or ((singl* or doubl* or treb* or tripl*) adj (blind$3 or mask$3)).tw. or Placebos/ or placebo*.tw. |
2748860 |
|
7 |
Epidemiologic studies/ or case control studies/ or exp cohort studies/ or Controlled Before-After Studies/ or Case control.tw. or cohort.tw. or Cohort analy$.tw. or (Follow up adj (study or studies)).tw. or (observational adj (study or studies)).tw. or Longitudinal.tw. or Retrospective*.tw. or prospective*.tw. or consecutive*.tw. or Cross sectional.tw. or Cross-sectional studies/ or historically controlled study/ or interrupted time series analysis/ [Onder exp cohort studies vallen ook longitudinale, prospectieve en retrospectieve studies] |
4772338 |
|
8 |
Case-control Studies/ or clinical trial, phase ii/ or clinical trial, phase iii/ or clinical trial, phase iv/ or comparative study/ or control groups/ or controlled before-after studies/ or controlled clinical trial/ or double-blind method/ or historically controlled study/ or matched-pair analysis/ or single-blind method/ or (((control or controlled) adj6 (study or studies or trial)) or (compar* adj (study or studies)) or ((control or controlled) adj1 active) or "open label*" or ((double or two or three or multi or trial) adj (arm or arms)) or (allocat* adj10 (arm or arms)) or placebo* or "sham-control*" or ((single or double or triple or assessor) adj1 (blind* or masked)) or nonrandom* or "non-random*" or "quasi-experiment*" or "parallel group*" or "factorial trial" or "pretest posttest" or (phase adj5 (study or trial)) or (case* adj6 (matched or control*)) or (match* adj6 (pair or pairs or cohort* or control* or group* or healthy or age or sex or gender or patient* or subject* or participant*)) or (propensity adj6 (scor* or match*))).ti,ab,kf. or (confounding adj6 adjust*).ti,ab. or (versus or vs or compar*).ti. or ((exp cohort studies/ or epidemiologic studies/ or multicenter study/ or observational study/ or seroepidemiologic studies/ or (cohort* or 'follow up' or followup or longitudinal* or prospective* or retrospective* or observational* or multicent* or 'multi-cent*' or consecutive*).ti,ab,kf.) and ((group or groups or subgroup* or versus or vs or compar*).ti,ab,kf. or ('odds ratio*' or 'relative odds' or 'risk ratio*' or 'relative risk*' or aor or arr or rrr).ab. or (("OR" or "RR") adj6 CI).ab.)) |
5733132 |
|
9 |
4 and 5 - SR |
60 |
|
10 |
(4 and 6) not 9 - RCT |
63 |
|
11 |
(4 and (7 or 8)) not (9 or 10) - observationeel |
360 |
|
12 |
9 or 10 or 11 |
483 |