Management of lumbar spinal stenosis: a survey among Dutch spine surgeons

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 supporttheseareoftenlacking,especiallyintermsoftheirrelative benefitandriskcomparedwithothertreatmentoptions.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 appliedin 12%of allsurgeryfor LSS.Mostsurgeonsconsidered 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.