This 2012 JAAOS review by Issack et al covers the full clinical arc of degenerative lumbar spinal stenosis — from the biomechanical cascade that narrows the canal, to diagnosis, to the evidence base for nonsurgical and surgical management options including laminectomy, MIS techniques, and interspinous devices.
When a patient with neurogenic claudication fails conservative management, the SPORT data support surgical decompression as definitively superior for pain and function — but counsel patients that the natural history is not inevitably progressive and that long-term surgical benefit, while real, narrows over a decade.
Reserve fusion for documented spondylolisthesis, scoliosis, or iatrogenic instability; decompression alone is sufficient for isolated stenosis.
This 2012 JAAOS review by Issack et al covers the full clinical arc of degenerative lumbar spinal stenosis — from the biomechanical cascade that narrows the canal, to diagnosis, to the evidence base for nonsurgical and surgical management options including laminectomy, MIS techniques, and interspinous devices.
When a patient with neurogenic claudication fails conservative management, the SPORT data support surgical decompression as definitively superior for pain and function — but counsel patients that the natural history is not inevitably progressive and that long-term surgical benefit, while real, narrows over a decade.
Reserve fusion for documented spondylolisthesis, scoliosis, or iatrogenic instability; decompression alone is sufficient for isolated stenosis.