Management of degenerative lumbar spinal stenosis: an evidence-based review

Abstract

Lumbar spinal stenosis has become one of the most disabling pathologies in the elderly population.Some additional conditions such as foraminal stenosis or degenerative spondylosis with a history of back pain and leg pain must be considered before treatment.A completely appropriate protocol and unified management of spinal stenosis have not yet been well defined.The objective of this literature review is to provide evidence-based recommendations reflected in the highest-quality clinical literature available to address key clinical questions surrounding the management of degenerative lumbar spinal stenosis.Cite this article: Covaro A, Vilà-Canet G, García de Frutos A, Ubierna MT, Ciccolo F, Caceres E. Management of degenerative lumbar spinal stenosis: an evidence-based review article. EFORT Open Rev 2016;1:267-274. DOI: 10.1302/2058-5241.1.000030.

A Randomized Double‐Blind Controlled Pilot Study Comparing Leucocyte‐Rich Platelet‐Rich Plasma and Corticosteroid in Caudal Epidural Injection for Complex Chronic Degenerative Spinal Pain

“…This disorder is commonly correlated with the complex heterogeneous condition of spine degeneration 2 . The clinical approach to managing degenerative spinal pain can be highly variable 3 . Treatments are aimed towards pain relief and return to an acceptable level of function.…”

“…Over the past 3 decades, epidural corticosteroid injections have become a standard part of the multimodal pain management algorithm for the treatment of low back pain, whether as a result of chronic spinal deformities or conditions associated with acute radicular pain. They are also frequently used in the treatment of chronic degenerative spine pain 3 . Despite the widespread use of epidural corticosteroid injections as a modality for chronic degenerative spine pain, its effectiveness remains controversial 3,4 …”

Patient-Reported Outcomes Following Lumbar Decompression Surgery: A Review of 2699 Cases

“…1 Lumbar decompression has demonstrated efficacy over conservative management for the treatment of radicular symptoms in trials; however, results of large-scale systematic reviews are neutral. [2][3][4][5][6][7][8][9][10] There are a multitude of surgical decompression strategies to decompress neural structures with no convincing evidence to support one technique over another. [11][12][13][14][15][16] These may be augmented by instrumentation to achieve vertebral fusion, correction of deformity, or structural imbalance.…”

“…43 This affords the surgeon a common language with which to communicate the purpose and indications supporting surgery, as well as the likelihood of improvement. 3,44 The aim of this study was to review a large dataset from our extensive and growing spinal surgery database to evaluate outcomes of simple decompression surgery from the patient's perspective.…”

The modified transforaminal endoscopic technique in treating intracanalicular combining foraminal and/or extraforaminal lumbar disc herniations

“…Of these subtypes, Chang defined the central and paracentral herniations as intracanalicular LDH, and extraforaminal herniation was defined as far-lateral LDH (2). While intracanalicular combining foraminal and/or extraforaminal LDH (ICFE-LDH) at one segment is a special and complicated type of LDH (3). Patients with ICFE-LDH often suffer multiple and unbearable radiculopathy since compressions on exiting and traversing nerve roots simultaneously (4), and it is easily to be missed in diagnosis.…”