Introduction: Lumbar spinal stenosis (LSS) is the most common reasons for lumbar surgery in the elderly population. Despite the rise of new minimally invasive surgical techniques, laminectomy is seen as the golden standard treatment. There are a variety of new surgical and conservative treatment options that are performed in clinical practice to treat LSS. Due to lack of consensus, the management may vary. Hence, a survey among neurosurgeons was conducted to assess possible variation in surgical management of LSS globally.
Methods: All members of the Congress of Neurological Surgeons (CNS) were sent an invitation to partake in this survey using an Internet-based survey tool. This survey contained eighteen questions which consisted professional history of the surgeons and evaluated the surgical management as well as the expectation of certain conservative and operative treatment options for LSS.
Results: A total of 384 patients answered the questionnaire (response rate of 15.6%). Conservative treatment was considered a necessity in all cases before surgery by more than half of the neurosurgeons (55.7%). Physical therapy was regarded to be the most effective for 75.6% of the surgeons. The open laminectomy with facetectomy was the preferred procedure for the majority of neurosurgeons (56.4%), followed by the unilateral laminotomy with crossover(41.4%). The laminectomy was also expected not only to be the most effective surgical treatment for LSS (94.3%) but also simultaneously have the highest risk for postoperative low back pain. Also the risk of other complications was expected to be the highest after a laminectomy (56.8%).
Conclusion : This survey showed that the majority of neurosurgeons still prefer the laminectomy with facetectomy as a treatment option for LSS. Still, there was some disparity between the effectiveness of the other surgical techniques. To minimize this variety, high-quality evidence and protocols are needed on the ideal surgical management of LSS.
