Degenerative lumbar spinal stenosis: current strategies in diagnosis and treatment.

Abstract

INTRODUCTION: Although the aging of the population is causing a dramatic rise in the incidence of lumbar spinal stenosis, the indications and options for surgical treatment are not clearly defined. METHODS: In an attempt to aid clinical decision making, a selective literature review was conducted, taking into account the guidelines of the Association of the Scientific Medical Societies in Germany (AWMF). RESULTS: In degenerative lumbar spinal stenosis hypertrophy of the facet joints and yellow ligaments brings about constriction of the spinal canal, leading to back pain and activity-dependent lower limb symptoms (neurogenic claudication). If conservative treatment fails, an imaging study, usually magnetic resonance imaging, is required. In the case of severe symptoms the progressive underlying degeneration necessitates surgical treatment. Minimally invasive fenestration techniques are usually employed to decompress the spinal canal; in the presence of instability, fusion is indicated. DISCUSSION: Despite the proven superiority of surgery in the management of refractory lumbar spinal stenosis, there is a lack of evidence-based data regarding the different surgical treatment options. The evaluation of modern, minimally invasive techniques is thus difficult.