[Surgical treatment of spinal stenosis]

Surgical treatment of lumbar spinal stenosis is aimed at decompressing the structures of the spinal canal. Several surgical techniques have been described over the last few years. This article gives a survey of the surgical procedures used for the treatment of spinal stenosis. When comparing and discussing indications and current surgical techniques used for spinal stenosis, one can describe some general tendencies: if the symptoms are severe or disabling and do not respond to appropriate conservative treatment, or if the patient is not able to cope with the pain any longer and views his or her quality of life as unacceptable, surgery is indicated. If the symptoms are mainly radicular, (microsurgical) decompression should be performed. If back pain is the main problem combined with preoperative evidence of segmental instability, spondylolisthesis, or scoliosis, one should consider spinal fusion in addition to an appropriate decompression. Further investigations are necessary to exactly find out the appropriate indications for a fusion and to answer the question of whether spinal instrumentation should be used.