[Lumbar spinal stenosis. An overview 50 years following initial description]

Area of Science:

• Orthopedics
• Neurosurgery
• Spinal Surgery

Background:

• Lumbar spinal stenosis (LSS) and neurogenic intermittent claudication (NIC) have been described for 50 years.
• LSS is primarily caused by segmental degenerative instability in spondylosis, originating from disc degeneration.
• This instability drives the pathophysiology of LSS and its associated symptoms.

Purpose of the Study:

• To provide an update on current concepts and new experiences in lumbar spinal stenosis.
• To highlight the importance of addressing segmental degenerative instability in LSS treatment.
• To discuss surgical strategies for LSS, emphasizing the need to treat both compression and instability.

Main Methods:

• Review of current concepts and clinical experience in lumbar spinal stenosis.
• Analysis of the pathophysiology linking disc degeneration, segmental instability, and LSS symptoms.
• Evaluation of surgical decompression techniques, including selective decompression and spinal fusion.

Main Results:

• Segmental degenerative instability is the key lesion in LSS, not separate entities.
• Radiological findings of stenosis do not always correlate with clinical symptoms.
• Complete laminectomy is often insufficient for adequate decompression; selective decompression is preferred.

Conclusions:

• Surgery for LSS must address both root compression and degenerative instability.
• Decompression alone treats the consequence (compression) but not the cause (instability).
• A combined approach of selective decompression and spinal fusion (e.g., translaminar screw fixation) is recommended for most LSS cases.