Methodological Quality of the Studies
Studies focusing on initial diagnostic imaging were mostly of low to moderate quality or had serious to critical risk of bias (Table 2). One study on preoperative blood tests in ASA grade I patients respected 9/10 cases series quality criteria22, while another met half of these criteria.38 Among studies on initial consultation and therapeutic interventions (Table 3), those on spine consultation after a thoracolumbar transverse process fracture had serious risk of bias. Among studies evaluating immobilization, RCTs had serious risk of bias or some concerns were identified, while systematic reviews were of low to critically low quality. Similarly, for post-treatment imaging and follow-up consultations (Table 4), systematic reviews were of critically low quality, RCTs had high risk of bias, retrospective studies had moderate to critical risk of bias and only 17 of 32 case series (n=17/32) met at least 70% of methodological quality criteria (Table 4).