Journal of Clinical Anesthesia and Research
- ISSN: 2577-3003
Eliezer Soto and Michael Esposito
Lumbar spinal stenosis is a common degenerative condition of the spine with high prevalence in the aging population. It is considered a clinical syndrome of buttock or lower extremity pain, with or without back pain, caused by a reduction of the space available for the neurovascular components. Classic features of lumbar spinal stenosis on physical exam include forward flexion of the spine on ambulation with limited range of motion. It requires diagnostic imaging for further pathology characterization. Traditionally, the treatment for lumbar spinal stenosis-related pain had been limited to open lumbar decompression after failure of conservative management. For the past decade, there has been a preference for minimally invasive techniques to treat patients that are not surgical candidates and to avoid possible complications from open lumbar decompression. Several minimally invasive options have become available for patients with mild to moderate lumbar spinal stenosis including: percutaneous image guided lumbar decompression, interspinous spacers, interspinous fixation devices and neuromodulation. The severity of the stenosis, the presence of multilevel disease, instability and/or neurologic symptoms as well as and selecting the correct index level, are some of the factors to be considered when choosing a technique. A literature search was performed through September 2023, reporting on effectiveness of nonsurgical and surgical treatments of lumbar spinal stenosis, using PubMed and EMBASE. The purpose of this article is to review the available treatment options for this patient population, and to create a treatment algorithm including indications and specific patient selection criteria for each technique.