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Stenosis & Instability

Lumbar spinal stenosis and associated instability — diagnostic criteria, management of neurogenic claudication, and decompression vs fusion indications.

Overview

For most patients, spinal stenosis is successfully managed with nonsurgical interventions [1]. Surgical success rates as high as 85% have been reported, though these may be compromised by inadequate decompression, inadequate stabilization, or medical comorbidities [13]. In the absence of segmental instability, arthrodesis is not necessary after decompression of the lumbar spine in patients who have degenerative lumbar spinal stenosis, provided that the stabilizing posterior elements of the spine are preserved during the operation [2]. Adding fusion to decompression has no place in the treatment of lumbar stenosis, with or without stable degenerative spondylolisthesis, as fusion can lead to worse outcomes resulting from new stenoses [5]. Furthermore, adding fusion surgery to decompression surgery did not improve outcomes at 2 years in patients with lumbar spinal stenosis [10].

The best indications for the lumbar laminoplasty procedure were young and active patients with central spinal stenosis [21]. Both percutaneous endoscopic decompression via a translaminar approach and percutaneous endoscopy conventional channels nerve decompression via a transforaminal approach can achieve satisfactory clinical efficacy in treating degenerative lumbar 4/5 spinal stenosis [19]. With appropriate indications, the open PLIF group and the UBE group had similar short- and medium-term clinical outcomes for the treatment of lumbar spinal stenosis [43]. Patients in the UBE group had better symptomatic improvement than the open PLIF group at 3 months postoperatively [43], and the effect on postoperative adjacent vertebral instability was smaller in the endoscopic group than in the open PLIF group [43].

There is a need for consensus on well-defined, unambiguous radiological criteria to define lumbar spinal stenosis in order to improve diagnostic accuracy and to formulate reliable inclusion criteria for clinical studies [8]. Researchers and clinicians must first agree on definitions for key concepts such as instability and reoperations [12].

Anatomy & Pathophysiology

Osseous and Morphological Factors

Spinal stenosis is defined as a narrowing or stricture of the spinal canal [3], yet narrowing alone does not explain all symptoms of the clinical syndrome, which involves pathoanatomical and pathophysiological changes from aging [3]. In patients with L4 isthmic spondylolisthesis, displacement occurs between the anterior and posterior elements of L4, primarily as separation during flexion [16]. Symptomatic degenerative lumbar spinal stenosis (DLSS) onset is highly associated with a combination of lumbar spine characteristics, including bony canal and vertebral body dimensions, rather than a sole variable [31]. Facet orientation and facet tropism in the lower lumbar spine are significantly associated with degenerative lumbar spinal stenosis [37]. In the cervical spine, sagittalization of the facet joints is a potential factor in the development of degenerative cervical spinal stenosis, though the specific underlying mechanism requires further study [35]. For developmental spinal stenosis, canal size is independent of body stature [49], while abnormal orientations of lamina angle and facet joint angulation may be developmental variations leading to an increased likelihood of the condition [49].

Ligamentous and Soft Tissue Integrity

A lumbar spine with posterior complex integrity is less likely to develop segment instability than a lumbar spine with a destroyed anchoring point for the supraspinous ligament [51]. Changes in the deep muscles at the back of the neck are key factors in the development of cervical instability [36].

Kinematics and Instability

Abnormal spinal motion and compression in spinal stenosis may not correlate with imaging severity [3]. The prevalence of lumbar segmental mobility disorders is higher when defined using the normalised within-subjects contribution-to-total-lumbar-motion approach [34]. Lumbar lateral instability leads to worse impacts on patient-reported outcomes when patients change positions, such as getting out of a car, rising from a chair, and climbing stairs [44]. The one-hole split endoscope (OSE) technique has no significant impact on lumbar spine stability in the early postoperative period [52].

Clinical Assessment and Pathophysiology

Physical examination of the spine includes inspection, palpation, range of motion testing, and neurologic evaluation to identify spinal pathology [39]. The lumbar extension-loading test is useful for assessing lumbar spinal stenosis pathology and can accurately determine the involved spinal level [45]. Psychological factors outmatched morphological markers in predicting limitations in activities of daily living and participation in patients with lumbar stenosis [42]. Parameters associated with low back pain should be taken into consideration when assessing low back pain in patients with lumbar spinal stenosis [46].

Classification

Clinical Phenotype: Spinal stenosis is defined as a narrowing or stricture of the spinal canal, though narrowing alone does not explain all symptoms [3]. The clinical syndrome involves pathoanatomical and pathophysiological changes from aging, including abnormal spinal motion and compression that may not correlate with imaging severity [3]. The natural history of lumbar spinal stenosis differs according to the grade of maximal central and foraminal stenoses [6]. In degenerative lumbar spinal stenosis patients, the stenotic segments of the spinal canal are more atrophied than the non-stenotic segment [47].

Diagnostic Criteria: MRI may overestimate stenosis severity in approximately 12% of cases [7]. There is a need for consensus on well-defined, unambiguous radiological criteria to define lumbar spinal stenosis in order to improve diagnostic accuracy and to formulate reliable inclusion criteria for clinical studies [8]. No clinically applicable and validated classification of spinal stenosis has been published [20].

Surgical Implications: For most patients, spinal stenosis is successfully managed with nonsurgical interventions [1]. In the absence of segmental instability, arthrodesis is not necessary after decompression of the lumbar spine in patients who have degenerative lumbar spinal stenosis, provided that the stabilizing posterior elements of the spine are preserved during the operation [2]. Radiographic co-existing cervical stenosis did not affect surgical outcomes for lumbar spinal canal stenosis, although symptomatic cervical lesions affected neurological scores after lumbar surgery [9].

Other Considerations: Patients with Loeys-Dietz syndrome have a high prevalence of cervical instability, particularly a pattern of instability at C2-C3 associated with C3 vertebral body hypoplasia and C2-C3 focal kyphosis [14].

Clinical Presentation

For most patients, spinal stenosis is successfully managed with nonsurgical interventions [1]. The clinical syndrome involves pathoanatomical and pathophysiological changes from aging, including abnormal spinal motion and compression that may not correlate with imaging severity [3]. Narrowing alone does not explain all symptoms [3], and the natural history differs according to the grade of maximal central and foraminal stenoses [6]. MRI may overestimate stenosis severity in approximately 12% of cases [7]. A narrow dural sac, demonstrated by myelography or computed tomography, reliably indicates central spinal stenosis [23].

Classification: No clinically applicable and validated classification of spinal stenosis has been published, which has substantially limited the development of an evidence-based algorithm for treatment [20]. There is a need for consensus on well-defined, unambiguous radiological criteria to define lumbar spinal stenosis in order to improve diagnostic accuracy and to formulate reliable inclusion criteria for clinical studies [8].

Instability Assessment: In the absence of segmental instability, arthrodesis is not necessary after decompression of the lumbar spine in patients who have degenerative lumbar spinal stenosis, provided that the stabilizing posterior elements of the spine are preserved during the operation [2]. Patients with lumbar spinal stenosis have a high prevalence of cervical instability, particularly a pattern of instability at C2-C3 associated with C3 vertebral body hypoplasia and C2-C3 focal kyphosis [14]. Nontraumatic upper cervical spine instability is a rare condition in children that can lead to permanent neurologic compromise if not diagnosed and managed correctly [15]. A study revealed the occurrence of displacement between the anterior and posterior elements of L4, primarily in the form of separation during flexion, in patients with L4 isthmic spondylolisthesis under weight-bearing conditions [16].

Red Flags and Comorbidities: Radiographic co-existing cervical stenosis did not affect surgical outcomes for lumbar spinal canal stenosis, although symptomatic cervical lesions affected neurological scores after lumbar surgery [9]. Most symptomatic cases of adult isthmic spondylolisthesis are successfully managed nonsurgically [26]. Patients with intractable pain or neurologic symptoms may benefit from surgical decompression and stabilization, which has shown >80% success in appropriately selected patients [26]. There is no uniform agreement in management for tandem spinal stenosis, and surgical strategies include both simultaneous and staged approaches [27].

Investigations

Plain radiography: Radiographic co-existing cervical stenosis did not affect surgical outcomes for lumbar spinal canal stenosis [9]. In patients with L4 isthmic spondylolisthesis under weight-bearing conditions, displacement occurs between the anterior and posterior elements of L4, primarily in the form of separation during flexion [16].

MRI: MRI may overestimate stenosis severity in approximately 12% of cases [7]. MRI findings failed to show a major clinical relevance when evaluating the walking distance in patients with lumbar spinal stenosis and, therefore, should be treated with some caution as a predictor of walking distance [56]. Among persons previously selected for surgery, lateral stenosis seen on MRI correlates with EMG and thus may be a clinically significant finding [57].

CT: A narrow dural sac, demonstrated by myelography or computed tomography, reliably indicates central spinal stenosis [23].

Other Considerations: For most patients, spinal stenosis is successfully managed with nonsurgical interventions [1]. In the absence of segmental instability, arthrodesis is not necessary after decompression of the lumbar spine in patients who have degenerative lumbar spinal stenosis, provided that the stabilizing posterior elements of the spine are preserved during the operation [2]. Spinal stenosis is a narrowing or stricture of the spinal canal where narrowing alone does not explain all symptoms [3]. The clinical syndrome of spinal stenosis involves pathoanatomical and pathophysiological changes from aging, including abnormal spinal motion and compression that may not correlate with imaging severity [3]. The natural history of lumbar spinal stenosis differs according to the grade of maximal central and foraminal stenoses [6]. There is a need for consensus on well-defined, unambiguous radiological criteria to define lumbar spinal stenosis in order to improve diagnostic accuracy and to formulate reliable inclusion criteria for clinical studies [8]. Symptomatic cervical lesions affected neurological scores after lumbar surgery in patients with tandem spinal stenosis [9]. Patients with Loeys-Dietz syndrome have a high prevalence of cervical instability, particularly a pattern of instability at C2-C3 associated with C3 vertebral body hypoplasia and C2-C3 focal kyphosis [14]. Nontraumatic upper cervical spine instability is a rare condition in children that can lead to permanent neurologic compromise if not diagnosed and managed correctly [15]. Adding fusion to a decompression increased the rate of new stenosis on two-year MRI, even when a spondylolisthesis was present preoperatively [29].

Treatment

Non-Operative

For most patients with lumbar spinal stenosis, the condition is successfully managed with nonsurgical interventions [1]. Recent prospective randomized studies have demonstrated that surgery is superior to nonsurgical management in terms of controlling pain and improving function in patients with lumbar spinal stenosis [38]. In patients with moderate lumbar spinal stenosis, decompressive surgery reduced pain and disability more than nonoperative treatment did [50]. Most symptomatic cases of adult isthmic spondylolisthesis are successfully managed nonsurgically [26], with nonoperative treatment being the preferred approach in most symptomatic patients and successful in as many as 60% [53].

Operative

Indications: Surgical intervention is indicated for patients with intractable pain or neurologic symptoms from adult isthmic spondylolisthesis, where decompression and stabilization has shown >80% success in appropriately selected patients [26]. Operative treatment of lumbar stenosis and degenerative spondylolisthesis offered a significant benefit over nonoperative treatment in patients at least eighty years of age [41].

Surgical Approach / Technique: In patients with degenerative lumbar spinal stenosis without segmental instability, arthrodesis is not necessary after decompression provided the stabilizing posterior elements are preserved [2]. Adding fusion to decompression has no place in the treatment of lumbar stenosis, with or without stable degenerative spondylolisthesis, as fusion can lead to worse outcomes resulting from new stenoses [5]. In patients with lumbar spinal stenosis, adding fusion surgery to decompression surgery did not improve outcomes at 2 years [10]. Staged surgery can effectively achieve neurological functional recovery in patients with multi-segment spinal stenosis in thoracic and lumbar regions, with favorable efficacy and safety [24]. It is a safe and feasible minimally invasive surgical treatment method for multi-level lumbar spinal stenosis using the unilateral biportal endoscopic technique [30]. Treatment of lumbar spinal stenosis by endoscopic transforaminal decompression can achieve good clinical results [32]. Both percutaneous endoscopic large channels nerve decompression through a translaminar approach and percutaneous endoscopy conventional channels nerve decompression through a transforaminal approach can achieve satisfactory clinical efficacy in treating degenerative lumbar 4/5 spinal stenosis [19]. The best indications for the lumbar laminoplasty procedure were young and active patients with central spinal stenosis [21]. All patients with mild, moderate, and severe lumbar spinal stenosis achieved curative effects after oblique lumbar interbody fusion (OLIF) surgery, though patients with severe stenosis had poorer outcomes compared to mild and moderate groups [22]. OLIF combined with pedicle screw fixation is effective in treating severe central lumbar spinal stenosis [33]. There were high heterogeneity and no significant differences in clinical outcomes, complication rates, and reoperation rates between endoscopic foraminotomy and fusion for the treatment of lumbar foraminal stenosis, although endoscopic foraminotomy has reduced operative time [25].

Implant Selection: No specific implant design choices are supported by the provided evidence base.

Alignment / Balancing Strategy: No specific alignment strategies are supported by the provided evidence base.

Pain Management: No specific analgesia regimens are supported by the provided evidence base.

Adjuncts: No specific adjuncts are supported by the provided evidence base.

Setting of Care: No specific setting of care data is supported by the provided evidence base.

Revision: Surgical success rates for degenerative lumbar stenosis can be as high as 85%, but may be compromised by inadequate decompression, inadequate stabilization, or medical comorbidities [13].

Other Considerations: No additional operative-decision evidence is present in the source bullets.

Complications

Instability: In the absence of segmental instability, arthrodesis is not necessary after decompression of the lumbar spine in patients with degenerative lumbar spinal stenosis if stabilizing posterior elements are preserved [2]. However, adding fusion to a decompression increased the rate of new stenosis on two-year MRI, even when a spondylolisthesis was present preoperatively [29]. Narrowing alone does not explain all symptoms of spinal stenosis; the clinical syndrome involves pathoanatomical and pathophysiological changes from aging, including abnormal spinal motion and compression that may not correlate with imaging severity [3].

Adjacent Segment Disease: Adjacent segment disease occurs in approximately 3% of patients per year, with an expected incidence of 25% within the first 10 years following fusion [17]. Adding fusion to decompression has no place in the treatment of lumbar stenosis, with or without stable degenerative spondylolisthesis, as fusion can lead to worse outcomes resulting from new stenoses [5].

Surgical Outcomes and Failure: Surgical success rates as high as 85% have been reported for degenerative lumbar stenosis, but may be compromised by inadequate decompression, inadequate stabilization, or medical comorbidities [13]. Patients with lumbar spinal stenosis with long-term preoperative leg numbness have poorer outcomes at 2 years postoperatively [28]. Adding fusion surgery to decompression surgery did not improve outcomes at 2 years in patients with lumbar spinal stenosis [10]. There were high heterogeneity and no significant differences in clinical outcomes, complication rates, and reoperation rates between endoscopic foraminotomy and fusion for the treatment of lumbar foraminal stenosis [25].

Other Considerations: Spinal stenosis is successfully managed with nonsurgical interventions for most patients [1]. MRI may overestimate stenosis severity in approximately 12% of cases [7]. Radiographic co-existing cervical stenosis did not affect surgical outcomes for lumbar spinal canal stenosis, although symptomatic cervical lesions affected neurological scores after lumbar surgery [9].

Recovery

Light activity (weeks): Most patients achieve successful management of spinal stenosis through nonsurgical interventions, allowing for early mobilization [1]. However, patients presenting with severe intermittent claudication require careful follow-up as they remain significant candidates for deterioration despite the initial success of conservative treatment [58].

Full activity (months): Surgical success rates can reach as high as 85%, though these outcomes may be compromised by inadequate decompression, inadequate stabilization, or medical comorbidities [13]. In the absence of segmental instability, arthrodesis is not necessary after decompression of the lumbar spine in patients with degenerative lumbar spinal stenosis, provided that the stabilizing posterior elements are preserved during the operation [2]. Conversely, adding fusion to decompression has no place in the treatment of lumbar stenosis, with or without stable degenerative spondylolisthesis, as fusion can lead to worse outcomes resulting from new stenoses [5]. In patients with lumbar spinal stenosis, adding fusion surgery to decompression surgery did not improve outcomes at 2 years [10].

Complete recovery / outcome plateau (months): The natural history of lumbar spinal stenosis differs according to the grade of maximal central and foraminal stenoses [6]. Patients with lumbar spinal stenosis with long-term preoperative leg numbness have poorer outcomes at 2 years postoperatively [28]. All patients with mild, moderate, and severe lumbar spinal stenosis achieved curative effects after OLIF surgery, though patients with severe stenosis had poorer outcomes compared to mild and moderate groups [22]. Staged surgery can effectively achieve neurological functional recovery in patients with multi-segment spinal stenosis in thoracic and lumbar regions, with favorable efficacy and safety [24]. Radiographic co-existing cervical stenosis did not affect surgical outcomes for lumbar spinal canal stenosis, although symptomatic cervical lesions affected neurological scores after lumbar surgery [9]. Adjacent segment disease occurs in approximately 3% of patients per year, with an expected incidence of 25% within the first 10 years following fusion [17]. MRI may overestimate stenosis severity in approximately 12% of cases [7]. Long-term follow-up is needed to study clinical effects of percutaneous transforaminal endoscopic decompression with removal of the posterosuperior region underneath the slipping vertebral body for lumbar spinal stenosis with degenerative lumbar spondylolisthesis [54].

Rehabilitation protocol: No specific rehabilitation protocol, PT phasing, or immobilisation duration is detailed in the provided evidence base.

Functional milestones: No specific validated PROM trajectories or outcome-measure benchmarks (e.g., Constant, ASES, WOMAC) are detailed in the provided evidence base.

Other Considerations: The natural history of lumbar spinal stenosis differs according to the grade of maximal central and foraminal stenoses [6]. Patients with severe intermittent claudication should be carefully followed up because they are significant candidates for deterioration despite the success of conservative treatment [58]. Radiographic co-existing cervical stenosis did not affect surgical outcomes for lumbar spinal canal stenosis, although symptomatic cervical lesions affected neurological scores after lumbar surgery [9]. Patients with lumbar spinal stenosis with long-term preoperative leg numbness have poorer outcomes at 2 years postoperatively [28].

Key Evidence

  • [L3] For most patients, spinal stenosis is successfully managed with nonsurgical interventions. (10.5435/jaaos-d-24-00760)
  • [L2] In the absence of segmental instability, arthrodesis is not necessary after decompression of the lumbar spine in patients who have degenerative lumbar spinal stenosis, provided that the stabilizing posterior elements of the spine are preserved during the operation. (10.2106/00004623-199507000-00009)
  • [L5] Spinal stenosis is a narrowing or stricture of the spinal canal where narrowing alone does not explain all symptoms; the clinical syndrome involves pathoanatomical and pathophysiological changes from aging, including abnormal spinal motion and compression that may not correlate with imaging severity. (10.2106/00004623-199904000-00016)
  • [L5] Adding fusion to decompression has no place in the treatment of lumbar stenosis, with or without stable degenerative spondylolisthesis, as fusion can lead to worse outcomes resulting from new stenoses. (10.1302/0301-620x.104b12.bjj-2022-1131)
  • [L3] The natural history of lumbar spinal stenosis differs according to the grade of maximal central and foraminal stenoses. (10.1186/s12891-022-05510-7)
  • [L3] However, MRI may overestimate stenosis severity in approximately 12% of cases. (10.5435/jaaos-d-25-00122)
  • [L1] There is a need for consensus on well-defined, unambiguous radiological criteria to define lumbar spinal stenosis in order to improve diagnostic accuracy and to formulate reliable inclusion criteria for clinical studies. (10.1186/1471-2474-12-175)
  • [L3] Radiographic co-existing cervical stenosis did not affect surgical outcomes for lumbar spinal canal stenosis, although symptomatic cervical lesions affected neurological scores after lumbar surgery. (10.1186/s13018-018-0765-6)
  • [L1] In patients with lumbar spinal stenosis, adding fusion surgery to decompression surgery did not improve outcomes at 2 years. (10.2106/jbjs.16.00885)
  • [L2] Researchers and clinicians must first agree on definitions for key concepts such as instability and reoperations. (10.1186/s12891-015-0548-8)
  • [L5] Surgical success rates as high as 85% have been reported, but may be compromised by inadequate decompression, inadequate stabilization, or medical comorbidities. (10.5435/00124635-199907000-00004)
  • [L4] Patients have a high prevalence of cervical instability, particularly a pattern of instability at C2-C3 associated with C3 vertebral body hypoplasia and C2-C3 focal kyphosis. (10.2106/jbjs.n.00680)
  • [L5] Nontraumatic upper cervical spine instability is a rare condition in children that can lead to permanent neurologic compromise if not diagnosed and managed correctly. (10.5435/00124635-200604000-00005)
  • [L3] This study revealed the occurrence of displacement between the anterior and posterior elements of L4, primarily in the form of separation during flexion. (10.1186/s13018-024-05033-y)
  • [L5] Adjacent segment disease occurs in approximately 3% of patients per year, with an expected incidence of 25% within the first 10 years following fusion. (10.5435/jaaos-21-01-3)
  • [L3] Both surgical methods can achieve satisfactory clinical efficacy in treating degenerative lumbar 4/5 spinal stenosis. (10.1186/s12891-025-08623-x)
  • [L5] No clinically applicable and validated classification of spinal stenosis has been published, which has substantially limited the development of an evidence-based algorithm for treatment. (10.5435/jaaos-d-15-00034)
  • [L4] The best indications for the lumbar laminoplasty procedure were young and active patients with central spinal stenosis. (10.2106/jbjs.e.00211)
  • [L3] All patients with mild, moderate, and severe lumbar spinal stenosis achieved curative effects after OLIF surgery, though patients with severe stenosis had poorer outcomes compared to mild and moderate groups. (10.1186/s13018-023-03913-3)
  • [L3] A narrow dural sac, demonstrated by myelography or computed tomography, reliably indicates central spinal stenosis. (10.2106/00004623-198567020-00009)
  • [L4] Staged surgery can effectively achieve neurological functional recovery in patients with multi-segment spinal stenosis in thoracic and lumbar regions, with favorable efficacy and safety. (10.1186/s12891-015-0672-5)
  • [L1] There were high heterogeneity and no significant differences in clinical outcomes, complication rates, and reoperation rates between endoscopic foraminotomy and fusion for the treatment of lumbar foraminal stenosis; although endoscopic foraminotomy has reduced operative time. (10.1530/eor-22-0093)
  • [L5] Most symptomatic cases of adult isthmic spondylolisthesis are successfully managed nonsurgically, but patients with intractable pain or neurologic symptoms may benefit from surgical decompression and stabilization, which has shown >80% success in appropriately selected patients. (10.5435/00124635-200910000-00003)
  • [L5] This article aims to provide the reader with details on the prevalence, evaluation, and guidance in treatment strategy for tandem spinal stenosis, noting that there is no uniform agreement in management and that surgical strategies include both simultaneous and staged approaches. (10.5435/jaaos-d-18-00726)
  • [L3] Patients with lumbar spinal stenosis with long-term preoperative leg numbness have poorer outcomes at 2 years postoperatively. (10.1186/s13018-022-03452-3)
  • [L1] Adding fusion to a decompression increased the rate of new stenosis on two-year MRI, even when a spondylolisthesis was present preoperatively. (10.1302/0301-620x.104b12.bjj-2022-0340.r1)
  • [L4] It is a safe and feasible minimally invasive surgical treatment method for multi-level lumbar spinal stenosis. (10.1186/s13018-024-04575-5)
  • [L3] Our results indicate that combination of lumbar spine characteristics such as bony canal and vertebral body dimensions rather than the presence of a sole variable is highly associated with symptomatic DLSS onset. (10.1186/s12891-023-06330-z)
  • [L4] Treatment of lumbar spinal stenosis by endoscopic transforaminal decompression can achieve good clinical results. (10.1186/s12891-020-3076-0)
  • [L4] OLIF combined with pedicle screw fixation is effective in treating severe central lumbar spinal stenosis. (10.1186/s12891-025-08675-z)
  • [L3] Prevalence was higher using the normalised within-subjects contribution-to-total-lumbar-motion approach. (10.1186/1471-2474-7-45)
  • [L3] Further studies are needed to elicit the specific underlying mechanism between sagittalization of the cervical facet joints and the pathology of CSS. (10.1186/s12891-024-07279-3)
  • [L3] Changes in the deep muscles at the back of the neck are key factors in the development of cervical instability. (10.1186/s12891-025-08594-z)
  • [L3] Facet orientation and facet tropism in the lower lumbar spine are significantly associated with degenerative lumbar spinal stenosis. (10.1155/2020/2453503)
  • [L5] Recent prospective randomized studies have demonstrated that surgery is superior to nonsurgical management in terms of controlling pain and improving function in patients with lumbar spinal stenosis. (10.5435/jaaos-20-08-527)
  • [L2] Operative treatment of lumbar stenosis and degenerative spondylolisthesis offered a significant benefit over nonoperative treatment in patients at least eighty years of age. (10.2106/jbjs.n.00313)
  • [L4] Early monitoring of these predictors should therefore be conducted in every spine centre. (10.1186/s12891-019-2918-0)
  • [L3] With appropriate indications, the open PLIF group and the UBE group had similar short- and medium-term clinical outcomes for the treatment of lumbar spinal stenosis, but patients in the UBE group had better symptomatic improvement than the open PLIF group at 3 months postoperatively, and the effect on postoperative adjacent vertebral instability was smaller in the endoscopic group than in the open PLIF group. (10.1186/s13018-023-04038-3)
  • [L3] The existence of lumbar lateral instability leads to worse impacts on patient-reported outcomes when patients change positions, including getting out of a car, rising from a chair, and climbing stairs. (10.1186/s12891-022-05017-1)
  • [L4] The lumbar extension-loading test is useful for assessment of lumbar spinal stenosis pathology and is capable of accurately determining the involved spinal level. (10.1186/1471-2474-15-259)
  • [L3] These parameters should be taken into consideration when assessing low back pain in patients with SLSS. (10.1186/s12891-022-05483-7)
  • [L3] The stenotic segments of the spinal canal are more atrophied than the non-stenotic segment in DLSS patients. (10.1186/s12891-021-04411-5)
  • [L2] Canal size is independent of body stature, and abnormal orientations of lamina angle and facet joint angulation may be developmental variations leading to increased likelihood of developmental spinal stenosis. (10.1302/0301-620x.103b4.bjj-2020-1792.r1)
  • [L1] In patients with moderate lumbar spinal stenosis, decompressive surgery reduced pain and disability more than nonoperative treatment did. (10.2106/jbjs.8908.ebo2)
  • [L5] A lumbar spine with posterior complex integrity is less likely to develop segment instability than a lumbar spine with a destroyed anchoring point for supraspinous ligament. (10.1186/1471-2474-9-84)
  • [L4] The OSE technique has no significant impact on lumbar spine stability in the early postoperative period. (10.1186/s12891-024-07443-9)
  • [L4] Nonoperative treatment is the preferred approach in most symptomatic patients and is successful in as many as 60%. (10.5435/00124635-199607000-00004)
  • [L4] However, long-term follow-up is needed to study clinical effects. (10.1186/s12891-024-07267-7)
  • [L3] MRI findings failed to show a major clinical relevance when evaluating the walking distance in patients with lumbar spinal stenosis and, therefore, should be treated with some caution as a predictor of walking distance. (10.1186/1471-2474-9-89)
  • [L3] Among persons previously selected for surgery, lateral stenosis seen on MRI correlates with EMG, and thus may be a clinically significant finding. (10.1186/1471-2474-15-247)
  • [L3] Patients with severe intermittent claudication should be carefully followed up because they are significant candidates for deterioration despite the success of conservative treatment. (10.1186/s13018-018-0947-2)

See Also

References

[1] The Clinical Status of Patients With Lumbar Spinal Stenosis Reflects Their Individual Decision to Undergo or Defer Lumbar Spinal Surgery. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00760

[2] Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis.. The Journal of Bone & Joint Surgery. 1995. DOI: 10.2106/00004623-199507000-00009

[3] Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Spinal Stenosis†. The Journal of Bone & Joint Surgery*. 1999. DOI: 10.2106/00004623-199904000-00016

[5] No need to add fusion to lumbar decompression for stenosis. The Bone & Joint Journal. 2022. DOI: 10.1302/0301-620x.104b12.bjj-2022-1131

[6] Probability for surgical treatment in patients with lumbar spinal stenosis according to the stenotic lesion severity: a 5–10-year follow-up study. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05510-7

[7] Surgical Threshold Measurements for Cervical Spinal Stenosis: Post-Myelogram Computed Tomography Versus MRI. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-25-00122

[8] Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review. BMC Musculoskeletal Disorders. 2011. DOI: 10.1186/1471-2474-12-175

[9] Surgical outcomes for lumbar spinal canal stenosis with coexisting cervical stenosis (tandem spinal stenosis): a retrospective analysis of 565 cases. Journal of Orthopaedic Surgery and Research. 2018. DOI: 10.1186/s13018-018-0765-6

[10] In Patients with Lumbar Spinal Stenosis, Adding Fusion Surgery to Decompression Surgery Did Not Improve Outcomes at 2 Years. Journal of Bone and Joint Surgery. 2016. DOI: 10.2106/jbjs.16.00885

[12] Arguments for the choice of surgical treatments in patients with lumbar spinal stenosis – a systematic appraisal of randomized controlled trials. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0548-8

[13] Degenerative Lumbar Stenosis: Diagnosis and Management. Journal of the American Academy of Orthopaedic Surgeons. 1999. DOI: 10.5435/00124635-199907000-00004

[14] High Prevalence of Cervical Deformity and Instability Requires Surveillance in Loeys-Dietz Syndrome. Journal of Bone and Joint Surgery. 2015. DOI: 10.2106/jbjs.n.00680

[15] Nontraumatic Upper Cervical Spine Instability in Children. Journal of the American Academy of Orthopaedic Surgeons. 2006. DOI: 10.5435/00124635-200604000-00005

[16] Segmental vertebral three-dimensional motion in patients with L4 isthmic spondylolisthesis under weight-bearing conditions. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-05033-y

[17] Adjacent Segment Disease Following Cervical Spine Surgery. Journal of the American Academy of Orthopaedic Surgeons. 2012. DOI: 10.5435/jaaos-21-01-3

[19] Comparison of clinical efficacy between Percutaneous Endoscopic Large channels nerve decompression through Translaminar approach and Percutaneous Endoscopy Conventional channels nerve decompression through Transforaminal approach for the treatment of degenerative L4/5 spinal stenosis: a retrospective study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08623-x

[20] Lumbar Spinal Stenosis: How Is It Classified?. Journal of the American Academy of Orthopaedic Surgeons. 2016. DOI: 10.5435/jaaos-d-15-00034

[21] Clinical and Radiographic Results of Expansive Lumbar Laminoplasty in Patients with Spinal Stenosis. Journal of Bone and Joint Surgery. 2005. DOI: 10.2106/jbjs.e.00211

[22] Effect of the preoperative assessment of the anteroposterior diameters of the spinal canal and dural area on the efficacy of oblique lumbar interbody fusion in patients with lumbar spinal stenosis. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03913-3

[23] Role of computed tomography and myelography in the diagnosis of central spinal stenosis.. The Journal of Bone & Joint Surgery. 1985. DOI: 10.2106/00004623-198567020-00009

[24] Multilevel thoracic ossification of ligamentum flavum coexisted with/without lumbar spinal stenosis: staged surgical strategy and clinical outcomes. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0672-5

[25] SPINE: High heterogeneity and no significant differences in clinical outcomes of endoscopic foraminotomy vs fusion for lumbar foraminal stenosis: a meta-analysis. EFORT Open Reviews. 2023. DOI: 10.1530/eor-22-0093

[26] Adult Isthmic Spondylolisthesis. Journal of the American Academy of Orthopaedic Surgeons. 2009. DOI: 10.5435/00124635-200910000-00003

[27] Evaluation and Treatment of Tandem Spinal Stenosis. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-18-00726

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[44] Analysis of lumbar lateral instability on upright left and right bending radiographs in symptomatic patients with degenerative lumbar spondylolisthesis. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05017-1

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