LUMBAR SPINAL STENOSIS: TREATMENT OPTIONS AND RESULTS

Abstract

A variety of modalities are available for the treatment of lumbar spinal stenosis. The nonoperative treatment techniques include anti-inflammatories, physical therapy and steroid injections. Controlled, randomized trials of these various treatment modalities have not been undertaken. The available data suggest that nonoperative treatment modalities have a sustained benefit in a minority of patients. The majority of patients who present with symptoms and signs of stenosis do not improve with nonoperative treatment, but typically do not progress over the short term. The indication to operate is based upon the severity of symptoms and the degree of associated disability. Decompressive operative techniques available for stenosis include a laminectomy, laminectomy and mesial facetectomy and laminotomies. The techniques vary in their degree of technical difficulty and the likelihood of incurring complications. The principle of decompressive surgery is to effect adequate decompression of the neural elements without inducing instability. Indications to proceed with segmental fusion are not clear. Overall, results of incorporating a fusion along with a decompression are better than with a decompression alone in selected patients, although there is an associated increase in complication potential.