title: Management of lumbar spinal stenosis: a survey among Dutch spine surgeons.
abstract: BACKGROUND
  Various surgical and non-surgical treatments for lumbar spinal stenosis (LSS) are widely adopted in clinical practice, but high quality randomised controlled trials to support these are often lacking, especially in terms of their relative benefit and risk compared with other treatment options. Therefore, an evaluation of agreement among clinicians regarding the indications and the choice for particular treatments seems appropriate.
  
  
  METHODS
  One hundred and six Dutch neurosurgeons and orthopaedic spine surgeons completed a questionnaire, which evaluated treatment options for LSS and expectations regarding the effectiveness of surgical and non-surgical treatments.
  
  
  RESULTS
  Responders accounted for 6,971 decompression operations and 831 spinal fusion procedures for LSS annually. Typical neurogenic claudication, severe pain/disability, and a pronounced constriction of the spinal canal were considered the most important indications for surgical treatment by the majority of responders. Non-surgical treatment was generally regarded as ineffective and believed to be less effective than surgical treatment. Interlaminar decompression was the preferred technique by 68% of neurosurgeons and 52% orthopaedic surgeons for the treatment of LSS. Concomitant fusion was applied in 12% of all surgery for LSS. Most surgeons considered spondylolisthesis as an indication and spinal instability as a definite indication for additional fusion.
  
  
  CONCLUSIONS
  The current survey demonstrates a wide variety of preferred treatments of symptomatic LSS by Dutch spine surgeons. To minimise variety, national and international protocols based on high-quality randomised controlled trials and systematic reviews are necessary to give surgeons more tools to support everyday decision-making.
authors.affiliation: Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands, g.m.overdevest@lumc.nl.
authors.forename: Gijsbert M
authors.initials: GM
authors.lastname: Overdevest
authors.forename: Wouter A
authors.initials: WA
authors.lastname: Moojen
authors.forename: Mark P
authors.initials: MP
authors.lastname: Arts
authors.forename: Carmen L A M
authors.initials: CL
authors.lastname: Vleggeert-Lankamp
authors.forename: Wilco C H
authors.initials: WC
authors.lastname: Jacobs
authors.forename: Wilco C
authors.initials: WC
authors.lastname: Peul
mesh_terms: D003661:Decision Support Techniques; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D009426:Netherlands; D009493:Neurosurgery; D009985:Orthopedics; D010146:Pain / Q000209:etiology / Q000601:surgery; D059408:Pain Management; D026741:Physical Therapy Modalities; D010818:Practice Patterns, Physicians'; D012720:Severity of Illness Index; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000150:complications / Q000628:therapy*; D013168:Spondylolisthesis / Q000209:etiology / Q000628:therapy