Conservative Treatment and Percutaneous Pain Relief Techniques in Patients with Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations.
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
Journal
World neurosurgery: X
ISSN: 2590-1397
Titre abrégé: World Neurosurg X
Pays: United States
ID NLM: 101747743
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
25
02
2020
accepted:
25
03
2020
entrez:
3
7
2020
pubmed:
3
7
2020
medline:
3
7
2020
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 32613192
doi: 10.1016/j.wnsx.2020.100079
pii: S2590-1397(20)30010-7
pii: 100079
pmc: PMC7322792
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100079Informations de copyright
© 2020 The Authors.
Références
Drug Des Devel Ther. 2015 Aug 13;9:4657-67
pubmed: 26316704
Cochrane Database Syst Rev. 2016 Jan 29;(1):CD010264
pubmed: 26824399
Arch Phys Med Rehabil. 2018 Dec;99(12):2408-2419.e2
pubmed: 29935152
J Bodyw Mov Ther. 2015 Apr;19(2):205-12
pubmed: 25892373
Arch Phys Med Rehabil. 2017 Aug;98(8):1499-1507.e2
pubmed: 28396242
Pak J Med Sci. 2018 Jul-Aug;34(4):968-973
pubmed: 30190763
Eur Spine J. 2016 Apr;25(4):1266-81
pubmed: 26906169
Eur Spine J. 2017 Feb;26(2):488-500
pubmed: 27981454
Turk Neurosurg. 2012;22(2):200-6
pubmed: 22437295
Pain Pract. 2019 Mar;19(3):250-274
pubmed: 30369003
N Engl J Med. 2014 Jul 3;371(1):11-21
pubmed: 24988555
Physiotherapy. 2013 Mar;99(1):12-20
pubmed: 23219644
Pain Med. 2016 Dec;17(12):2185-2202
pubmed: 28025354
Pain Physician. 2013 Apr;16(2 Suppl):S49-283
pubmed: 23615883
Anesth Pain Med. 2015 Aug 22;5(4):e29716
pubmed: 26484298
J Orthop Sports Phys Ther. 2017 Sep;47(9):593-615
pubmed: 28704626
Spine (Phila Pa 1976). 2009 Jan 1;34(1):49-59
pubmed: 19127161
J Orthop. 2017 Oct 27;15(1):1-8
pubmed: 29167604
Biomed Imaging Interv J. 2011 Jan-Mar;7(1):e4
pubmed: 21655113
Nat Rev Neurol. 2009 Jul;5(7):392-403
pubmed: 19578346
Pain Physician. 2012 Sep-Oct;15(5):371-84
pubmed: 22996849
Spine (Phila Pa 1976). 2009 May 1;34(10):1078-93
pubmed: 19363456
Anesth Pain Med. 2015 Feb 01;5(1):e23139
pubmed: 25789241
N Engl J Med. 2008 Feb 21;358(8):794-810
pubmed: 18287602
Pain Physician. 2016 Mar;19(3):E365-410
pubmed: 27008296
World J Orthop. 2016 May 18;7(5):315-37
pubmed: 27190760
Man Ther. 2011 Aug;16(4):308-17
pubmed: 21367646
J Rehabil Med. 2014 Nov;46(10):1046-9
pubmed: 25187993
BMC Musculoskelet Disord. 2010 Nov 02;11:254
pubmed: 21044326
Pain Physician. 2015 Jan-Feb;18(1):79-92
pubmed: 25675062
Drug Des Devel Ther. 2015 Jan 30;9:707-16
pubmed: 25678775
Phys Ther. 2013 Dec;93(12):1646-60
pubmed: 23886845
PLoS One. 2011;6(11):e27991
pubmed: 22140497
Pain Physician. 2009 Mar-Apr;12(2):437-60
pubmed: 19305489
Complement Ther Med. 2013 Oct;21(5):535-56
pubmed: 24050593
Spine J. 2018 Apr;18(4):639-647
pubmed: 28870836
J Exerc Rehabil. 2015 Oct 30;11(5):272-5
pubmed: 26535218
Pain Physician. 2012 Nov-Dec;15(6):E909-53
pubmed: 23159980
Acupunct Med. 2016 Aug;34(4):267-74
pubmed: 26953235
Int J Surg. 2017 Aug;44:329-338
pubmed: 28705591
BMC Complement Altern Med. 2018 Jan 19;18(1):19
pubmed: 29351748
Spine J. 2014 Aug 1;14(8):1611-21
pubmed: 24373681
BMC Musculoskelet Disord. 2009 Oct 01;10:121
pubmed: 19796387
J Neurosurg Spine. 2014 Jul;21(1):79-90
pubmed: 24980590
Pain Physician. 2015 Nov;18(6):E939-1004
pubmed: 26606031
Spine J. 2017 Sep;17(9):1209-1214
pubmed: 28428080
Clin Radiol. 2017 Jan;72(1):96.e7-96.e14
pubmed: 27639917
Pain Med. 2016 Feb;17(2):239-49
pubmed: 26593277
AJNR Am J Neuroradiol. 2012 Sep;33(8):1419-26
pubmed: 21940805
Pain Physician. 2015 Jul-Aug;18(4):E535-82
pubmed: 26218948
BMJ. 2016 Jan 04;352:h6234
pubmed: 26727925
Pain. 2018 May;159(5):876-883
pubmed: 29394207
J Manipulative Physiol Ther. 2016 Feb;39(2):88-94
pubmed: 26907616
Surg Neurol Int. 2015 May 07;6(Suppl 4):S194-235
pubmed: 26005584
Anesthesiology. 2018 Sep;129(3):517-535
pubmed: 29847426
J Orthop Sci. 2018 Mar;23(2):282-288
pubmed: 29352625