Consensus on a standardised treatment pathway algorithm for lumbar spinal stenosis: an international Delphi study.

Area of Science:

• Spinal Disorders
• Neurosurgery
• Rehabilitation Medicine

Background:

• Lumbar spinal stenosis (LSS) is a prevalent degenerative condition in older adults, causing significant disability and impacting quality of life.
• Current clinical decision-making for LSS is hampered by sparse and inconsistent evidence, leading to variable patient outcomes and healthcare inefficiency.
• Individual patient needs and symptom presentations in LSS vary considerably.

Purpose of the Study:

• To develop a treatment algorithm for Lumbar Spinal Stenosis (LSS) through international expert consensus.
• To create a multi-professional, stratified approach to LSS management.
• To provide a clinical guide for LSS treatment until further evidence supports a fully stratified care model.

Main Methods:

• A modified Delphi study involving four consensus rounds with international LSS experts.
• Development of distinct treatment pathways based on symptom type and severity.
• Evaluation of agreement with the proposed LSS treatment algorithm in a final consensus round.

Main Results:

• An algorithm combining stratified and stepped care approaches for LSS was finalized.
• Immediate investigation and surgery are recommended when indicated; otherwise, a stepped approach begins with self-directed care, progressing to rehabilitation, multidisciplinary care, and surgical options.
• 86% of 397 participants agreed with the algorithm, with over 70% deeming it useful for clinicians and potentially for patients in shared decision-making.

Conclusions:

• International multi-professional consensus was reached for the LSS treatment algorithm.
• The algorithm suggests varied treatment pathways based on clinical indications, serving as a guide for LSS management.
• Further evaluation of the algorithm's clinical and cost-effectiveness compared to current care is necessary.