Degenerative lumbar spinal stenosis in older people: current treatment options.
BACKGROUND
Degenerative lumbar spinal stenosis is increasingly being diagnosed in persons over age 65. In 2011, 55 793 older people with this condition were treated as inpatients in German hospitals. Among physicians, there is much uncertainty about the appropriate treatment strategy.


METHODS
Selective literature review.


RESULTS
Lumbar spinal stenosis in older people is characterized by spinal claudication and neurological deficits. A precise clinical history and physical examination and ancillary radiological studies are the necessary prerequisites for treatment. Magnetic resonance imaging is the radiological study of choice. Conservative treatment consists of physiotherapy, drugs, and local injections; various surgical treatments can be considered, depending on the severity of the problem. The main purpose of surgery is to decompress the spinal canal. If the lumbar spine is demonstrably unstable, an instrumented fusion should be performed in addition. There is, however, only moderately good evidence supporting the superiority of surgery over conservative treatment. In a prospective study, the complication rate of purely decompressive surgery was found to be 18%. The utility of the current operative techniques cannot be definitively assessed, because they are applied to a wide variety of patients in different stages of the disease and at different degrees of severity, and the reported results are thus not comparable from one trial to another.


CONCLUSIONS
No evidence-based recommendation on the diagnosis and treatment of lumbar spinal stenosis in older people can be formulated at present because of the lack of pertinent randomized trials.
Department of Neurosurgery, Jena University Hospital.
Rolf
R
Kalff
Christian
C
Ewald
Albrecht
A
Waschke
Lars
L
Gobisch
Christof
C
Hopf
D003131:Combined Modality Therapy; D019299:Decompression, Surgical / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D012064:Relaxation Therapy / Q000706:statistics & numerical data*; D012307:Risk Factors; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D013130:Spinal Stenosis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome