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

Abstract Background Although decompression is the basis of surgical treatment for lumbar spinal stenosis (LSS), under various circumstances instrumented fusion is performed as well. The rationale for mobility-preserving operations for lumbar spinal stenosis is preventing adjacent segment disease. We review the rationale for mobility preservation – ASD, discuss related topics such as indications for fusion and the evolving role of minimally invasive approaches to lumbar spine decompression. Our focus is on systematic review and consensus discussion of mobility-preserving surgical methods as related to surgery for lumbar spinal stenosis. Methods Groups of spinal surgeons, members of the WFNS spine committee, performed systematic reviews of dynamic fixation systems including hybrid constructs, and of interspinous process devices; consensus statements were generated based on the reviews, at two voting sessions by the committee several months apart. Additional review of background data was performed, and the results summarized in this review. Results Decompression is the basis of surgical treatment of lumbar spinal stenosis. Fusion is an option, especially when spondylolisthesis or instability are present, but indications remain controversial. Adjacent segment disease (ASD) incidence reports display high variability. ASD may represent the natural progression of degenerative disease in many cases. Older age, poor sagittal balance, multilevel fusion may be associated with more ASD. Dynamic fixation constructs are treatment options that may help prevent ASD.