Degenerative lumbar spinal stenosis in older people: current treatment options.

Because of the aging of the population, neurosurgeons, orthopedists, trauma surgeons, and spine surgeons are now increasingly confronted with a very wide variety of degenerative changes of the lumbar spine. The treatment of symptomatic lumbar spinal stenosis is surely among the major clinical challenges of this kind. As the available scientific evidence on the diagnosis and treatment of this entity is not very reliable (1, 2), there is no currently valid overall assessment of treatment strategies for older patients (i.e., persons over age 65). Not only do older people make up a higher percentage of the population than before; there has also been a disproportionate rise in the frequency of lumbar spinal surgery in this age group (3) (Figure 1). The precise nature of this rise is hard to determine, however, because of the broad range of spinal procedures that are performed, with widely varying degrees of complexity. In 2005, lumbar spinal stenosis (ICD-10 code M48.06) was given as the main admitting diagnosis of 28 001 hospitalized patients over age 65 in Germany. By 2011, this figure had more than doubled, to 55 793 (3). Figure 1 The number of Osteoporosis and other typical spinal problems of advanced age, multiple comorbidities, and the lessened physical performance that goes along with age are now accompanied, at least as far as our experience suggests, by markedly heightened expectations on the part of our older patients. Thus, the value of different treatment strategies needs to be rationally assessed. In this article, we ask what the existing scientific evidence tells us about the current methods of diagnosis and treatment of symptomatic lumbar spinal stenosis in older people. Possible treatment strategies are indicated. Spinal stenosis Neurosurgeons, orthopedists, trauma surgeons, and spine surgeons are now increasingly confronted with a very wide variety of degenerative changes of the lumbar spine.