Mobility-Preserving Surgery for Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations

Area of Science:

• Spine surgery
• Degenerative spine conditions
• Orthopedic surgery

Background:

• Decompression is the primary surgical treatment for lumbar spinal stenosis (LSS).
• Instrumented fusion is sometimes performed for LSS, but its indications are debated.
• Preventing adjacent segment disease (ASD) is a key rationale for mobility-preserving procedures.

Purpose of the Study:

• To review the rationale for mobility preservation in preventing ASD after LSS surgery.
• To discuss indications for fusion and the role of minimally invasive decompression.
• To provide a consensus on mobility-preserving surgical methods for LSS.

Main Methods:

• Systematic reviews of dynamic fixation systems and interspinous process devices were conducted by spinal surgeons.
• Consensus statements were generated through two voting sessions.
• Additional background data was reviewed and summarized.

Main Results:

• Decompression is the cornerstone of LSS surgical treatment.
• Fusion indications, particularly for spondylolisthesis or instability, are controversial.
• ASD incidence varies, and it may be a natural progression of degenerative disease; older age, poor sagittal balance, and multilevel fusion are associated risk factors.
• Dynamic fixation constructs offer a potential strategy to mitigate ASD.

Conclusions:

• Mobility-preserving approaches are crucial for managing LSS and preventing ASD.
• Dynamic fixation systems represent a promising option for reducing ASD risk.
• Further consensus and research are needed to refine surgical indications and techniques for LSS.