ReviewNorth American Spine Society journal2026
A pragmatic evaluation of outcome fragility in randomized clinical trials comparing open microdiscectomy and endoscopic-assisted discectomy: A meta-analysis.
Review in North American Spine Society journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
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Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: RCTs comparing endoscopic-assisted and open lumbar discectomy frequently show significant findings despite few events and inconsistent follow-up, undermining confidence in their robustness. Fragility analysis measures how easily significance disappears with minimal data changes. This study systematically examined the statistical and clinical fragility of trials contrasting these 2 surgical approaches. Methods: PubMed, Embase, and Cochrane CENTRAL were searched from January 2000 through December 2024 for RCTs comparing MD and EM for LDD. Dichotomous outcomes were evaluated using the fragility index (FI) and fragility quotient (FQ), while continuous outcomes were assessed using the continuous fragility index (CFI) and the continuous fragility quotient (CFQ). Practical fragility was determined by comparing fragility indices with the loss to follow-up (LTF). Outcomes were stratified by clinical categories for subgroup analyses. Results: Thirteen RCTs, including 1,826 patients, were included. We identified 108 dichotomous events, with a median FI of 4 (interquartile range [IQR], 3-6) and median FQ of 0.035. Neurological complications demonstrated the greatest statistical fragility, and the collective body of dichotomous events was practically fragile. About 138 continuous outcomes were analyzed, with a median CFI of 11 (IQR 6-17) and a CFQ of 0.17. Continuous outcomes were more statistically robust and not practically fragile. No significant correlation existed between statistical significance and fragility. Conclusions: RCTs comparing open and endoscopic-assisted microdiscectomy are frequently fragile, especially for dichotomous outcomes that often fall below LTF thresholds. Caution should be taken when interpreting these results, and the fragility metric can help maintain reporting veracity across orthopedic literature.
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