Clinical assessment and management of lumbar spinal stenosis: clinical dilemmas and considerations for surgical referral

David B Anderson; David J Beard; Francois Rannou; David J Hunter; Pradeep Suri; Lingxiao Chen; James M Van Gelder

doi:10.1016/S2665-9913(24)00028-6

Clinical assessment and management of lumbar spinal stenosis: clinical dilemmas and considerations for surgical referral

Lancet Rheumatol. 2024 Oct;6(10):e727-e732. doi: 10.1016/S2665-9913(24)00028-6. Epub 2024 May 6.

Authors

David B Anderson¹, David J Beard², Francois Rannou³, David J Hunter⁴, Pradeep Suri⁵, Lingxiao Chen⁶, James M Van Gelder⁷

Affiliations

¹ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Sydney Musculoskeletal Health, Patyegarang Precinct, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. Electronic address: [email protected].
² Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Division of Medical Sciences, University of Oxford, Oxford, UK.
³ Department of Physical and Rehabilitation Medicine, Hôpital Cochin, AP-HP Centre, Paris, France; UFR de Médecine, Faculté de Santé, Université Paris Cité, Paris, France; INSERM UMR-S 1124, Paris, France.
⁴ Sydney Musculoskeletal Health, Arabanoo Precinct, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Rheumatology Department, Royal North Shore Hospital, Sydney, NSW, Australia.
⁵ Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
⁶ Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
⁷ Concord Repatriation General Hospital, Neurosurgical Department, Sydney, NSW, Australia; School of Clinical Medicine, University of New South Wales Medicine and Health, University of New South Wales, Sydney, NSW, Australia.

PMID: 38723654
DOI: 10.1016/S2665-9913(24)00028-6

Abstract

Lumbar spinal stenosis is the leading indication for spine surgery in older adults. Surgery is recommended in clinical guidelines if non-surgical treatments have been provided with insufficient benefit. The difficulty for clinicians is that the current number of randomised controlled trials is low, which creates uncertainty about which treatments to provide. For non-surgical clinicians this paucity of data leads to a clinical dilemma of whether to continue managing the patient or refer to a spine surgeon. This Viewpoint aims to provide an update on the assessment of lumbar spinal stenosis, treatment recommendations, indications for referral to a spine surgeon, and current clinical dilemmas facing non-surgical clinicians and spinal surgeons.

Publication types

Review

MeSH terms

Humans
Lumbar Vertebrae* / surgery
Referral and Consultation*
Spinal Stenosis* / surgery
Spinal Stenosis* / therapy