The <scp>MIST</scp> Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment

Deer, Timothy R.; Grider, Jay S.; Pope, Jason E.; Falowski, Steven; Lamer, Tim J.; Calodney, Aaron; Provenzano, David; Sayed, Dawood; Lee, Eric; Wahezi, Sayed E.; Kim, Chong; Hunter, Corey; Gupta, Mayank; Benyamin, Rasmin; Chopko, Bohdan W.; Demesmin, Didier; Diwan, Sudhir; Gharibo, Christopher; Kapural, Leo; Kloth, David; Klagges, Brian D.; Harned, Michael E.; Simopoulos, Tom; McJunkin, Tory; Carlson, Jonathan D.; Rosenquist, Richard W.; Lubenow, Timothy R.; Mekhail, Nagy

doi:10.1111/papr.12744

Cited by 58 publications

(59 citation statements)

References 91 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…LSS is also a disease of the elderly who inherently carry a greater anesthetic risk. Minimally invasive and percutaneously inserted interspinous spacers have been shown to be both non-inferior in terms of patient outcomes and to have decisive benefits in terms of operating times and blood loss 2–26. This cohort of patients, the largest in a single study, confirms the existing cited literature which shows improvement in patient symptomatology and function after interspinous spacer insertion.…”

Section: Discussionsupporting

confidence: 74%

“…These include disc herniation, facet joint arthropathy and ligamentum flavum hypertrophy 1. A component of venous ischemia caused by compression of the venules around the spinal nerves has also been described 1 2. The resultant narrowing is exacerbated by truncal extension which exaggerates the natural lordosis of the lumbar spine, but is reduced with flexion when the lumbar spine is more kyphotic 3.…”

Section: Introductionmentioning

confidence: 99%

“…This pathophysiology underpins the classical presentation of lumbar spinal stenosis (LSS): progressive back, buttock and lower limb pain which comes on rapidly with ambulation (when the patient is naturally more extended) and relieved by sitting or lying (when the patient is naturally flexed). The changes in the spinal canal and associated ligaments have been demonstrated on dynamic MRI studies 1–4…”

Section: Introductionmentioning

confidence: 99%

“…Initial management is often conservative and can involve a combination of physical therapy, analgesia and local intervention with epidural or foraminal local anesthetic and steroid injections. If conservative treatment fails, conventional surgical treatment for LSS is decompression with either a laminectomy or laminotomy with or without posterior fusion 2. Interspinous spacers or percutaneous interspinous devices (PID) have been developed as an alternative, less invasive therapy.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Successful use of percutaneous interspinous spacers and adjunctive spinoplasty in a 9 year cohort of patients

Manfrè¹,

Vivo²,

Qatami

et al. 2020

J NeuroIntervent Surg

View full text Add to dashboard Cite

PurposeLumbar spinal canal stenosis and lumbar spinal foraminal stenosis are common, degenerative pathologies which can result in neurogenic claudication and have a negative impact on function and quality of life. Percutaneous interspinous devices (PIDs) are a recently-developed, minimally-invasive, alternative treatment option. This study details a 9 year single-centre experience with PIDs and examines the complementary use of spinous process augmentation (spinoplasty) to reduce failure rates.MethodsA retrospective cohort assessment of 800 consecutive patients who presented to a specialized spine hospital was performed with 688 receiving treatment. Inclusion was based on high-grade stenosis, failure of conservative management and electromyography. 256 had a PID alone while 432 had concurrent polymethyl methacrylate (PMMA) augmentation of the adjacent spinous processes. The patients were followed up at 3 and 12 months using the Zurich Claudication Questionnaire (ZCQ) and Oswestry Disability Index (ODI).ResultsBoth groups showed marked improvement in the patients’ ZCQ scores (3.2 to 1.3) and ODI scores (32 to 21), with strong satisfaction results (1.7). The symptom recurrence rate from complications for the group which received concurrent spinous process augmentation was reduced when compared with the PID alone cohort (<1% vs 11.3%).ConclusionThis study demonstrates the efficacy of percutaneous interspinous devices in treating lumbar spinal stenosis. It also provides evidence that concurrent spinous process augmentation reduces the rate of symptom recurrence.

show abstract

Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Successful use of percutaneous interspinous spacers and adjunctive spinoplasty in a 9 year cohort of patients

Manfrè¹,

Vivo²,

Qatami

et al. 2020

J NeuroIntervent Surg

View full text Add to dashboard Cite

show abstract

“…11 A cross-disciplinary consensus group using the US Preventive Services Task Force (USPSTF) criteria for evidence level and degree of recommendation performed a systematic review of all published studies of the mild procedure, which resulted in a strong consensus for the highest recommendation of the procedure for the treatment of LSS secondary to HLF. 13 The present study analysis retrospectively compared clinical outcomes of the mild procedure in two age groups: adults (age<65) and older adults (age≥65).…”

Section: Introductionmentioning

confidence: 99%

<p>The Impact of Age on the Outcomes of Minimally Invasive Lumbar Decompression for Lumbar Spinal Stenosis</p>

Mekhail

Costandi

Armanyous

et al. 2020

MDER

View full text Add to dashboard Cite

Background and Purpose: Minimally invasive lumbar decompression (mild ®) is an effective long-term therapy for patients with symptomatic lumbar spinal stenosis (LSS) resulting primarily from hypertrophic ligamentum flavum (HLF). Most subjects in clinical studies of the mild procedure have been older adults (age≥65). While the incidence of LSS increases with age, a substantial number of adults (age<65) also suffer from neurogenic claudication secondary to HLF. In this report, outcomes of mild were compared between adults and older adults. Patients and Methods: All prospective studies of the mild procedure with a 1-year follow-up completed since the beginning of 2012 that allowed the inclusion of adult patients of all ages were reviewed. Outcomes of visual analog scale (VAS), Oswestry Disability Index (ODI), Pain Disability Index (PDI), Roland Morris Low Back Pain and Disability Questionnaire (RMQ), standing time and walking distance were compared for adults and older adults. Results: Four studies met the inclusion criteria, resulting in an analysis of 49 adults and 160 older adults. Patients in both age groups experienced significant mean improvements in all but one outcome measure at 6-and 12-month follow-up. Differences between the two age groups in all scores at 6 and 12 months were not statistically significant. Conclusion: Analysis of the four studies indicated that symptom improvements for adults and older adults were significant from baseline, and no statistically significant difference was observed between the two age groups. These results illustrate that mild can be an effective treatment for LSS due primarily to HLF, regardless of the adult patient age.

show abstract

Diagnosis and Management of Lumbar Spinal Stenosis

Katz

Zimmerman

Mass

et al. 2022

JAMA

187

118

View full text Add to dashboard Cite

IMPORTANCE Lumbar spinal stenosis is a prevalent and disabling cause of low back and leg pain in older persons, affecting an estimated 103 million persons worldwide. Most are treated nonoperatively. Approximately 600 000 surgical procedures are performed in the US each year for lumbar spinal stenosis.OBSERVATIONS The prevalence of the clinical syndrome of lumbar spinal stenosis in US adults is approximately 11% and increases with age. The diagnosis can generally be made based on a clinical history of back and lower extremity pain that is provoked by lumbar extension, relieved by lumbar flexion, and confirmed with cross-sectional imaging, such as computed tomography or magnetic resonance imaging (MRI). Nonoperative treatment includes activity modification such as reducing periods of standing or walking, oral medications to diminish pain such as nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy. In a series of patients with lumbar spinal stenosis followed up for up to 3 years without operative intervention, approximately one-third of patients reported improvement, approximately 50% reported no change in symptoms, and approximately 10% to 20% of patients reported that their back pain, leg pain, and walking were worse. Long-term benefits of epidural steroid injections for lumbar spinal stenosis have not been demonstrated. Surgery appears effective in carefully selected patients with back, buttock, and lower extremity pain who do not improve with conservative management. For example, in a randomized trial of 94 participants with symptomatic and radiographic degenerative lumbar spinal stenosis, decompressive laminectomy improved symptoms more than nonoperative therapy (difference, 7.8 points; 95% CI, 0.8-14.9; minimum clinically important difference, 10-12.8) on the Oswestry Disability Index (score range, 0-100). Among persons with lumbar spinal stenosis and concomitant spondylolisthesis, lumbar fusion increased symptom resolution in 1 trial (difference, 5.7 points; 95% CI, 0.1 to 11.3) on the 36-Item Short Form Health Survey physical dimension score (range, 0-100), but 2 other trials showed either no important differences between the 2 therapies or noninferiority of lumbar decompression alone compared with lumbar decompression plus spinal fusion (MCID, 2-4.9 points). In a noninferiority trial, 71.4% treated with lumbar decompression alone vs 72.9% of those receiving decompression plus fusion achieved a 30% or more reduction in Oswestry Disability Index score, consistent with the prespecified noninferiority hypothesis. Fusion is associated with greater risk of complications such as blood loss, infection, longer hospital stays, and higher costs. Thus, the precise indications for concomitant lumbar fusion in persons with lumbar spinal stenosis and spondylolisthesis remain unclear.CONCLUSIONS AND RELEVANCE Lumbar spinal stenosis affects approximately 103 million people worldwide and 11% of older adults in the US. First-line therapy is activity modification, analgesia, and physical therapy. Long-term bene...

show abstract

The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment

Cited by 58 publications

References 91 publications

Successful use of percutaneous interspinous spacers and adjunctive spinoplasty in a 9 year cohort of patients

Successful use of percutaneous interspinous spacers and adjunctive spinoplasty in a 9 year cohort of patients

<p>The Impact of Age on the Outcomes of Minimally Invasive Lumbar Decompression for Lumbar Spinal Stenosis</p>

Diagnosis and Management of Lumbar Spinal Stenosis

Contact Info

Product

Resources

About