By Sebastian Arts
Lumbar stenosis is the narrowing of the spinal canal in the lumbar region, causing compression of the myelum. This results in lower back pain, neurogenic claudication and weakness and numbness in both legs. It is commonly caused by degeneration or osteoporosis and is associated with forward displacement of a vertebra called spondylolisthesis. Decompression through laminectomy is the first choice of treatment and is nowadays often supplemented with lumbar fusion (arthrodesis) in order to minimize the risk of future instability and deformity.
However, in a recently published randomized controlled trial, Försth et al. show that laminectomy combined with lumbar fusion does not result in significantly improved clinical outcomes compared to laminectomy alone, after five years. Moreover, laminectomy in combination with lumbar fusion is associated with longer surgical time, longer hospital stay and higher amounts of blood loss. Lastly, no difference was found in the need for reoperation 6.5 years after surgery between the decompression group and fusion group, 21% and 22% respectively.
An additional benefit is that mean costs were $6,800 less in the decompression group than in the fusion group, due to a shorter surgical time, shorter hospital stay and the absence of expensive implants.
In conclusion, decompression by laminectomy without arthrodesis seems sufficient in the treatment of lumbar stenosis. On top of that, the lower costs will probably be received warmly these days.
Peter Försth et al. N Engl J Med 2016; 374: 1413-1423