Conservative Treatment and Percutaneous Pain Relief Techniques in Patients with Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations

Maurizio Fornari; Scott C Robertson; Paulo Pereira; Mehmet Zileli; Carla D Anania; Ana Ferreira; Silvano Ferrari; Roberto Gatti; Francesco Costa

doi:10.1016/j.wnsx.2020.100079

Conservative Treatment and Percutaneous Pain Relief Techniques in Patients with Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations

World Neurosurg X. 2020 Jun 23:7:100079. doi: 10.1016/j.wnsx.2020.100079. eCollection 2020 Jul.

Authors

Maurizio Fornari¹, Scott C Robertson², Paulo Pereira³, Mehmet Zileli⁴, Carla D Anania¹, Ana Ferreira³, Silvano Ferrari⁵, Roberto Gatti⁵, Francesco Costa¹

Affiliations

¹ Neurosurgery Department, Humanitas Research Hospital, Rozzano, Milan, Italy.
² Neurosurgery Department, Laredo Medical Center, University of the Incarnate Word School of Osteopathic Medicine, Laredo, Texas, USA.
³ Department of Neurosurgery, University Hospital Center of São João and Faculty of Medicine of the University of Porto, Porto, Portugal.
⁴ Department of Neurosurgery, Ege University Faculty of Medicine, Bornova, Izmir, Turkey.
⁵ Humanitas University, Pieve Emanuele, Milan, Italy.

Abstract

Background: Degenerative lumbar spinal stenosis (LSS) is a progressive disease with potentially dangerous consequences that affect quality of life. Despite the detailed literature, natural history is unpredictable. This uncertainty presents a challenge making the correct management decisions, especially in patients with mild to moderate symptoms, regarding conservative or surgical treatment. This article focused on conservative treatment for degenerative LSS.

Methods: To standardize clinical practice worldwide as much as possible, the World Federation of Neurosurgical Societies Spine Committee held a consensus conference on conservative treatment for degenerative LSS. A team of experts in spinal disorders reviewed the literature on conservative treatment for degenerative LSS from 2008 to 2018 and drafted and voted on a number of statements.

Results: During 2 consensus meetings, 14 statements were voted on. The Committee agreed on the use of physical therapy for up to 3 months in cases with no neurologic symptoms. Initial conservative treatment could be applied without major complications in these cases. In patients with moderate to severe symptoms or with acute radicular deficits, surgical treatment is indicated. The efficacy of epidural injections is still debated, as it shows only limited benefit in patients with degenerative LSS.

Conclusions: A conservative approach based on therapeutic exercise may be the first choice in patients with LSS except in the presence of significant neurologic deficits. Treatment with instrumental modalities or epidural injections is still debated. Further studies with standardization of outcome measures are needed to reach high-level evidence conclusions.

Keywords: Conservative treatment; Follow-up of LSS; Guidelines; LBP, Low back pain; LS, Likert scale; LSS; LSS, Lumbar spinal stenosis; Lumbar spinal stenosis; PT, Physical therapy; Percutaneous pain relief techniques; RCT, Randomized controlled trial; WFNS, World Federation of Neurosurgical Societies.