Decompressive Surgery for Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations

Abstract

Objective: Lumbar spine stenosis is a common disease with a prevalence progressively increasing due to the aging of the population. Despite many papers having been published over the last decades, there still remain many doubts regarding its natural history and appropriate treatment. To overcome these problems and reach some globally accepted recommendations, the World Federation of Neurosurgical Society Spine Committee organized a consensus conference on this topic. This paper describes recommendations about the efficacy of surgical decompression, the difference between surgical techniques, and complications of surgery.

Methods: World Federation of Neurosurgical Society Spine Committee aimed to standardize clinical practice worldwide as much as possible and held a 2-round consensus conference on lumbar spinal stenosis. A team of expert spine surgeons reviewed literature regarding surgical treatment from over the last 10 years, and then drafted and voted on some statements based on the presented literature.

Results: Ten statements were voted. The committee agreed on the effectiveness of surgical decompression in patients with moderate-to-severe symptoms or with neurologic deficits. There was no consensus on the best surgical technique and, in particular, about the equivalence of microscopic techniques and an open approach. Regarding complications, we agreed that the most frequent complications are incidental durotomy and general complications in the elderly.

Conclusions: Surgical decompression represents the treatment of choice for symptomatic lumbar spinal stenosis with a low complication rate. However, which surgical technique is the best is still under debate. Further studies with standardized outcome measures are needed to understand the real complication rate and frequency of different unwanted events.

Keywords: Complications; Decompressive surgery; ID, Incidental durotomy; LSS, Lumbar spinal stenosis; Laminectomy; Lumbar spine stenosis; MIS, Minimally invasive surgery; MISS; RCT, Randomized controlled trial; Spine surgery; Surgical treatment; VAS, Visual analogue scale; WFNS, World Federation of Neurosurgical Societies.

Figure 1

Literature review process. MISS, minimally invasive spine surgery; LSS, lumbar spinal stenosis.

Figure 2

(A) Standard posterior approach with open laminectomy and facets sparing; (B) bilateral laminotomy; and (C) unilateral laminotomy with bilateral decompression; (B, C) consent posterior element preservation.