Surgical treatment of degenerative lumbar spinal stenosis

Degenerative lumbar spinal stenosis is the most common indication for lumbar spine surgery in adults over the age of 65. Although some studies have claimed improvement with conservative treatment, several comparative studies have shown better outcomes for surgical treatment for patients with moderate to severe stenosis. As the life expectancy of the elderly population increases, and by virtue of modern neuro-imaging, physicians and particularly neurosurgeons are being increasingly confronted with older patients suffering from disabling lumbar spinal stenosis. Many of these patients become candidates for corrective surgical procedures, because, despite advanced age, surgical decompression may lead to significant pain relief and improve the individual's quality of life. Traditionally, the surgical treatment of acquired lumbar stenosis has been wide laminectomy, which allows decompression of the neural structures by unroofing the spinal canal. The success rate of the procedure, however, is only 64%. The frequent surgical failures have been attributed to local tissue trauma, and to postoperative spinal instability, which has led to a dramatic increase in lumbar fusion surgery. Increasing knowledge of the pathoanatomy, coupled with highresolution imaging, has allowed a precise localization of nerve compression, which usually occurs at the level of the intervertebral space and the bulging yellow ligaments. Various authors have proposed more tailored and less invasive techniques in the treatment of acquired lumbar stenosis. In this review, five recent published papers regarding the management of lumbar spinal stenosis are presented and analyzed. This review tries to present to the readers the current surgical treatment options and trends, analyzing their features, their outcomes, and highlighting their impact on patients suffering lumbar spinal stenosis, who are generally adults over the age of 65 years with associated comorbidities. (1) TRENDS, MAJOR MEDICAL COMPLICATIONS, AND CHARGES ASSOCIATED WITH SURGERY FOR LUMBAR SPINAL STENOSIS IN OLDER ADULTS (JAMA. 2010 Apr 7; 303(13):1259-65)