The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment

Area of Science:

• Spine Surgery
• Interventional Pain Management
• Neurosurgery

Background:

• Lumbar spinal stenosis (LSS) causes neural compression, leading to low back and leg pain.
• Traditional treatments include conservative methods and invasive surgical decompression.
• Minimally invasive spine treatments (MISTs) have emerged as expanded treatment options for LSS.

Purpose of the Study:

• To evaluate peer-reviewed literature for minimally invasive spine treatment (MIST) recommendations for LSS.
• To establish consensus points, evidence strength, recommendation grades, and a treatment algorithm for LSS.

Main Methods:

• A Lumbar Spinal Stenosis Consensus Group reviewed literature on MISTs for LSS.
• Eleven consensus points were defined using U.S. Preventive Services Task Force criteria.
• Literature search identified 9 studies on MISTs and 1 RCT on spacers.

Main Results:

• Treatment choice for LSS depends on stenosis degree, level, architecture, symptom severity, prior treatments, and comorbidities.
• Level I evidence shows percutaneous image-guided lumbar decompression is superior to epidural steroid injection for LSS.
• One RCT supported the use of spacers in a noninferiority study comparing available products.

Conclusions:

• MISTs should be used judiciously and algorithmically for LSS, based on evidence of efficacy and safety.
• The MIST Consensus Group recommends MISTs be integrated into an evidence-based, multimodal decision algorithm for LSS management.