title: Management of Degenerative Lumbar Spinal Stenosis in the Elderly.
abstract: BACKGROUND
  Lumbar spinal stenosis can cause symptomatic neurogenic claudication alongside radicular pain and weakness. In appropriately selected patients, surgical intervention has been demonstrated to provide for improvement in pain, disability, and quality of life. This systematic review sought to define the utility and safety of such decompression with or without arthrodesis in the management of symptomatic lumbar spinal stenosis for elderly patients older than 65 years of age.
  
  
  METHODS
  A systematic review was conducted using MEDLINE for literature published through December 2014. The first question focused on the effectiveness of lumbar spinal surgery for symptomatic lumbar spinal stenosis in elderly patients (over age 65 y). The second question focused on safety of surgical intervention on this elderly population with emphasis on perioperative complication rates.
  
  
  RESULTS
  Review of 11 studies reveals that the majority of elderly patients exhibit significant symptomatic improvement, with overall benefits observed for pain (change visual analog scale 4.4 points) and disability (change Oswestry Disability Index 23 points). Review of 11 studies reveals that perioperative complications were infrequent and acceptable with pooled estimates of mortality (0.5%), inadvertent durotomy (5%), and wound infection (2%). Outcomes seem less favorable with greater complication rates among patients with diabetes or obesity.
  
  
  CONCLUSIONS
  Based on largely low-quality, retrospective evidence, we recommend that elderly patients should not be excluded from surgical intervention for symptomatic lumbar spinal stenosis.
authors.affiliation: *Division of Neurosurgery, Toronto Western Hospital, Toronto, Canada; ‡Department of Surgery, and §Techna Research Institute, University of Toronto, Toronto, Canada; ¶Center for Spine Health, Cleveland Clinic, Cleveland, Ohio; ‖Department of Orthopedic Surgery, Northwestern University, Chicago, Illinois; #The Core Institute, Phoenix, Arizona.
authors.forename: Mohammed F
authors.initials: MF
authors.lastname: Shamji
authors.forename: Thomas
authors.initials: T
authors.lastname: Mroz
authors.forename: Wellington
authors.initials: W
authors.lastname: Hsu
authors.forename: Norman
authors.initials: N
authors.lastname: Chutkan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods*; D019468:Disease Management; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D011788:Quality of Life; D012189:Retrospective Studies; D013130:Spinal Stenosis / Q000601:surgery*; D016896:Treatment Outcome