Degenerative Lumbar Spinal Stenosis. When and How Should We Operate On

  • Thomas Patsiaouras Former Director Orthopaedic dpt, Asklipiion Hospital - Voula-Athens
Keywords: Low Back Pain, Stenosis, Intermitted Claudication, Arthrodesis


Lumbar Spinal Stenosis is a degenerative spinal condition affecting 50% of patients usually over 50 years.

Is considering the end result of the degenerative cascade with compression of neural tissues by disc displacement anteriorly and by hypertrophy of facet joints and ligamentum flavun posteriorly. The main symptom except Low Back Pain  and sciatica is the Intermitted Claudication. There is no always correlation between clinical symptoms and the degree of stenosis in imaging studies. The natural history of LSS is unpredictable but some patient can be benefitted by the conservative treatment. We have to be aware from Cauda Equina Syndrome which is more insidious in LSS. Treatment options range from conservative to surgical according the degree of stenosis and the severity of clinical symptoms. In this article are described  the surgical techniques for decompression and the indications for concomitant arthrodesis in cases of instability  and deformity.


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1. Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, Hunter DJ. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. 2009 Jul;9(7):545-50.
2. Singh K, Samartzis D, Biyani A, An HS. Lumbar spinal stenosis. J Am Acad Orthop Surg 2008;16(3):171-6.. 3.Cheung JP, Samartzis D, Shigematsu H, et al Defining clinically relevant values for developmental spinal stenosis: a large-scale magnetic resonance imaging study. Spine 2014;39(13):1067-76. 4. Christy Tomkins-Lane, Markus Melloh, Jon Lurie et al. ISSLS Prize Winner:Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis. Results of an International Delphi Study. Spine vol 41 No 15 pp 1235-1246. 2016
5. Gen Inoue,Masayuki Miyagi,Masashi Takaso et al (2016) Surgical and nonsurgical treatment for Lumbar Spinal Stenosis. Eur J Orthop Surg Traumatol 2016 Οct 26: 695
6. Francisco Kovacs, Gerard Urrutia, Jose Alarcon. Surgery versus conservative treatment of symptomatic lumbar spinal stenosis:A systematic review of randomized controlled trials. SPINE Sep 15,2011 E1335-51
7. Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical Versus Nonsurgical Treatment for Lumbar Spinal Stenosis. Cochrane collaboration Spine. 2016 Jul 15;41(14):E857-68.
8. Clemens Weber,Charalambos Giannadakis ,Vidal Rao et al .Is there an association Between Radiological Severity of Lumbar Spinal Stenosis and Disability,Pain, or Surgical Outcome? A Multicenter Observational Study. SPINE 2016 jan 41 E78-83
9. Κonstantine Shizas, Nicolas Theumann Alexandre Burn et al Qualitatve grading of severity of lumar spinal stenosis based on the morphology of the Dural sac on Magnetic Resonance Images 2010. Oct 1.35.pp 1919-24
10. Kanamori,H.Matsui,N.Hirano et al Trumpet Laminectomy for Lumbar Degenerative Spinal Stenosis. J Spinal Disord 1993 Jan 6.pp 232-7
11. Kleeman TJ,Hiscoe AC.Berg EE.Patient outcome after minimally destabilizing lumbar stenosis decompression.The ‘Port-Hole’ technique SPINE 2000 Apr 1 pp 865-70
12. Spetzger U, Bertalanffy H, Naujokat C, von Keyserlingk DG, Gilsbach JM. Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part I: anatomical and surgical considerations. Acta Neurochir (Wien). 1997;139(5):392- 396. 4.
13. Sngbong Ko,and Taebum Oh.Comparison of bilateral decompression via unilateral laminotomy and conventional laminectomy for single-level degenerative lumbar spinal stenosis regarding low back pain functional outcome,and quality of life-A Randomized Controlled Prospective Trial Journal of Orthopaedic surgery and Research 2019 pp 1298-3
14. Fu YS et al Long term outcomes of two different decomperession tecniques for lumbar spinal stenosis. Clinical Trial SPINE 2008
15. Nils H.Ulrich,Jakob B. Burgstaller Giuseppe Pichierri et al. Decompressive surgery alone versus decompression plus Fusion in symptomatic Lumbar Spinal Stenosis. A Swiss Prospective Multicenter Cohort Study with 3 years FU. SPINE 2017 Vol. 42 No 18 pp E1077-1086
16. Forsth P.Olafsson G.Carlsson T et al A Randomized Controlled Trial of fusion surgery for lumbar spinal stenosis. Engl J Med 2016 Apr 14 pp1413-23
17. Erik Y. TyeJosqua Anderson Arnold Haas et al. Decompression Versus Decompression and Fusion for Degenerative Lumbar Stenosis in a Workers’ Compensation setting. SPINE 2017 Vol.42 No 13,pp 1017-1023
18. Rikke Rousing,Rikke Kruger Jensen,Soren Fruensgaard et al Danish National clinical guidelines for surgical and nonsurgical treatment of patients with lumbar spinal stenosis. Eur Spine J Jun 28 pp1386-1396
19. Greger Lonne, Peter Fritzell, Olle Hagg et al .Lumbar Spinal Stenosis: Comparison of Surgical Practice Variation and clinical outcome in three national spine registries. The Spine Journal 2019 (19) pp 41-49.
20. Rachid Bech-Azeddine,Soren Fruensgaard,Mikkel Andersen et al Outcomes of decompression without fusion in patients with lumbar spinal stenosis with back pain. Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S101!S140
21. Chenxu Wang,Xiang Yin,Liang Zhang et al Posterolateral fusion combined with posterior decompression shows superiority in the treatment of severe lumbar spinal stenosis without lumbar disc protrusion or prolapse. A retrospective study Journal of Orthopaedic Surgery and research 2020
22. Yoji Ogura, Yoshiomi Kobayashi,Yoshio Shinozaki et al Factors Influencing Patient Satisfaction after Decomressive Surgery without Fusion for Lumbar Spinal Stenosis .Global Spine Journal 2020, Vol. 10(5) 627-632.
23. Shreya Srinivas,Jerome Paquet,Chris Bailey et al Effect of Spinal decompression on back pain in lumbar spinal stenosis:a Canadian Spine Outcomes Research Network. (CSORN) study The Spine Journal 2019 (19) PP 1001-1008
24. Stromqvist BH,Berg S.Gerdhem P. et al.X-Stop versus decompressive surgery for lumbar neurogenic intermitted claudication: randomized controlled trial with 2-year follow-up.SPINE 2013 Aug 1.pp 1436-42
25. Vikas Patel,Peter Whang,Thomas HaleySuperior Interspinous Process Spacer for intermittent Neurogenic Claudication secondary to moderate lumbar spinal stenosis.A randomized trial.SPINE 2015 VOL 40No 5 pp 275-282
26. Bernard Meyer,Jean Charles Le Huec. A multicenter randomized controlled Clinical trial to evaluate the effectiveness and safety of a standalone percutaneous spacer versus decompressive surgery in degenerative lumpar spinal stenosis with neurogenic intermitted claudication. Global Spine Surgery 2016
27. We Sun et al Selective versus multi-segmental decompression and fusion for multi-segment lumbar spinal stenosis with single-segment degenerative spoindylolisthesis. J Orthop Surg Res 2019
28. Bai H,LI Y,Liu C et al Surgical management of Degenerative Lumbar Scoliosis Associated with Spinal Stenosis:Does PI-LL Matter? SPINE 2020 Aug 1,pp 1047-1054
29. Li Y, Ou Y, Zhu Y,He B, et al Effectiveness of short-segment fixation versus long-segment fixation for degenerative Scoliosis with cobb angle 20-40*. A retrospective observational study. Med Sci Monit 2020 Jul 22
30. William Slikker, AleIjandro Espinosa, Howard An et al Based Markers predict Dynamic Instability in Lumbar Degenerative Spondylolistesis. Neurospine 2020.17 pp 221-227
31. Jacob YL Oh,Jun-Hao Tan,Timothy WW Teo et al Spinal stenosis presenting with scrotal and perianal claudication. ASIAN SPINE J. 2020 pp 103-105
32. A.Perner,J.T.Andersen,M.Juh. Lower urinary tract symptoms in lumbar root compression syndromes:a prospective survey. SPINE 1997 Nov.15 (22) pp 2693-7
33. E. J. Wall, M.S. Cohen, B.Rydevic et al Cauda equine anatomy.I:Intrathecal nerve root organization. SPINE 1990 Dec 15 (12) pp 1244-7