Surgical and Nonsurgical Management of Lumbar Spinal Stenosis

Lumbar spinal stenosis (LSS) is characterised by the narrowing of the spinal canal in the lower back, leading to compression of neural structures and symptoms such as neurogenic claudication, radiculopathy and lower-limb pain. Management strategies are broadly divided into surgical decompression—where bone and soft tissue are removed to relieve pressure on neural elements—and nonsurgical approaches that encompass pharmacological therapy, structured exercise regimens, manual therapy and image-guided injections. Surgical options range from laminectomy and minimally invasive endoscopic techniques to decompression combined with spinal fusion or the implantation of interspinous process spacers. Nonsurgical care aims to control pain, improve function and enhance quality of life through a combination of physiotherapeutic interventions, tailored exercise programmes and epidural injections, often delivered in community or outpatient settings. Decision-making is guided by symptom severity, radiological findings, comorbidities and patient preference, with an increasing emphasis on shared decision-making and the integration of multidisciplinary pathways to optimise outcomes.

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Surgical and Nonsurgical Management of Lumbar Spinal Stenosis publication trend

The graph below shows the total number of articles in surgical and nonsurgical management of lumbar spinal stenosis across all publications each year (not limited to Nature Index journals).

Technical terms

Lumbar spinal stenosis: Narrowing of the spinal canal in the lumbar region leading to neural compression.

Neurogenic claudication: Pain, weakness and numbness in the legs precipitated by walking and relieved by flexion of the spine.

Decompression: Surgical removal of bone or soft tissue to relieve pressure on spinal nerves or the spinal cord.

Spinal fusion: Surgical joining of two or more vertebrae to stabilise the spine and reduce motion.

Interspinous process spacer: An implant placed between spinous processes to distract vertebral segments and maintain canal dimensions.

Biportal endoscopic spinal surgery: Minimally invasive technique using two small portals for endoscopic camera and instruments to achieve decompression.

References

1. How I do it? Biportal endoscopic spinal surgery (BESS) for treatment of lumbar spinal stenosis. Acta Neurochirurgica (2016).
2. Effectiveness of Surgery for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis. PLOS ONE (2015).
3. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis. JAMA Network Open (2019).