Timothy R Deer1, Jay S Grider2, Jason E Pope3, Steven Falowski4, Tim J Lamer5, Aaron Calodney6, David A Provenzano7, Dawood Sayed8, Eric Lee9, Sayed E Wahezi10, Chong Kim1, Corey Hunter11, Mayank Gupta12, Rasmin Benyamin13,14, Bohdan Chopko15, Didier Demesmin16, Sudhir Diwan17, Christopher Gharibo18, Leo Kapural19, David Kloth20, Brian D Klagges21, Michael Harned22, Tom Simopoulos23, Tory McJunkin24, Jonathan D Carlson25, Richard W Rosenquist26, Timothy R Lubenow27, Nagy Mekhail28. 1. Center for Pain Relief, Charleston, West Virginia, U.S.A. 2. UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A. 3. Evolve Restorative Clinic, Santa Rosa, California, U.S.A. 4. Functional Neurosurgery, St. Lukes University Health Network, Bethlehem, Pennsylvania, U.S.A. 5. Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A. 6. Texas Spine and Joint Hospital, Tyler, Texas, U.S.A. 7. Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, U.S.A. 8. University of Kansas Medical Center, Kansas City, Kansas, U.S.A. 9. Summit Pain Alliance, Sonoma, California, U.S.A. 10. Montefiore Medical Center, SUNY-Buffalo, Buffalo, New York, U.S.A. 11. Ainsworth Institute of Pain Management, New York, New York, U.S.A. 12. Anesthesiology and Pain Medicine, HCA Midwest Health, Overland Park, Kansas, U.S.A. 13. Millennium Pain Center, Bloomington, Illinois, U.S.A. 14. College of Medicine, University of Illinois, Urbana-Champaign, Illinois, U.S.A. 15. Stanford Health Care, Henderson, Nevada, U.S.A. 16. Rutgers Robert Wood Johnson Medical School, Department of Pain Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey, U.S.A. 17. Manhattan Spine and Pain Medicine, Lenox Hill Hospital, New York, New York, U.S.A. 18. Pain Medicine and Orthopedics, NYU Langone Hospitals Center, New York, New York, U.S.A. 19. Carolina's Pain Institute at Brookstown, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A. 20. Department of Anesthesiology, Danbury Hospital, Danbury, Connecticut, U.S.A. 21. Anesthesiology and Pain Medicine, Amoskeag Anesthesiology, Manchester, New Hampshire, U.S.A. 22. Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, U.S.A. 23. Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A. 24. Pain Doctor Inc., Phoenix, Arizona, U.S.A. 25. Arizona Pain, Midwestern Medical School, Glendale, Arizona, U.S.A. 26. Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A. 27. Rush University Medical Center, Chicago, Illinois, U.S.A. 28. Evidence-Based Pain Management Research and Education, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Abstract
BACKGROUND: Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back and leg pain. LSS has traditionally been treated with a variety of conservative (pain medications, physical therapy, epidural spinal injections) and invasive (surgical decompression) options. Recently, several minimally invasive procedures have expanded the treatment options. METHODS: The Lumbar Spinal Stenosis Consensus Group convened to evaluate the peer-reviewed literature as the basis for making minimally invasive spine treatment (MIST) recommendations. Eleven consensus points were clearly defined with evidence strength, recommendation grade, and consensus level using U.S. Preventive Services Task Force criteria. The Consensus Group also created a treatment algorithm. Literature searches yielded 9 studies (2 randomized controlled trials [RCTs]; 7 observational studies, 4 prospective and 3 retrospective) of minimally invasive spine treatments, and 1 RCT for spacers. RESULTS: The LSS treatment choice is dependent on the degree of stenosis; spinal or anatomic level; architecture of the stenosis; severity of the symptoms; failed, past, less invasive treatments; previous fusions or other open surgical approaches; and patient comorbidities. There is Level I evidence for percutaneous image-guided lumbar decompression as superior to lumbar epidural steroid injection, and 1 RCT supported spacer use in a noninferiority study comparing 2 spacer products currently available. CONCLUSIONS: MISTs should be used in a judicious and algorithmic fashion to treat LSS, based on the evidence of efficacy and safety in the peer-reviewed literature. The MIST Consensus Group recommend that these procedures be used in a multimodal fashion as part of an evidence-based decision algorithm.
BACKGROUND: Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back and leg pain. LSS has traditionally been treated with a variety of conservative (pain medications, physical therapy, epidural spinal injections) and invasive (surgical decompression) options. Recently, several minimally invasive procedures have expanded the treatment options. METHODS: The Lumbar Spinal Stenosis Consensus Group convened to evaluate the peer-reviewed literature as the basis for making minimally invasive spine treatment (MIST) recommendations. Eleven consensus points were clearly defined with evidence strength, recommendation grade, and consensus level using U.S. Preventive Services Task Force criteria. The Consensus Group also created a treatment algorithm. Literature searches yielded 9 studies (2 randomized controlled trials [RCTs]; 7 observational studies, 4 prospective and 3 retrospective) of minimally invasive spine treatments, and 1 RCT for spacers. RESULTS: The LSS treatment choice is dependent on the degree of stenosis; spinal or anatomic level; architecture of the stenosis; severity of the symptoms; failed, past, less invasive treatments; previous fusions or other open surgical approaches; and patient comorbidities. There is Level I evidence for percutaneous image-guided lumbar decompression as superior to lumbar epidural steroid injection, and 1 RCT supported spacer use in a noninferiority study comparing 2 spacer products currently available. CONCLUSIONS: MISTs should be used in a judicious and algorithmic fashion to treat LSS, based on the evidence of efficacy and safety in the peer-reviewed literature. The MIST Consensus Group recommend that these procedures be used in a multimodal fashion as part of an evidence-based decision algorithm.
Authors: Shaimaa I A Ibrahim; Judith A Strong; Katherine A Qualls; Yvonne M Ulrich-Lai; Jun-Ming Zhang Journal: Anesth Analg Date: 2020-07 Impact factor: 5.108
Authors: David Hao; Alp Yurter; Robert Chu; Mariam Salisu-Orhurhu; Henry Onyeaka; Jon Hagedorn; Kiran Patel; Ryan D'Souza; Susan Moeschler; Alan David Kaye; Vwaire Orhurhu Journal: Pain Ther Date: 2022-09-15
Authors: Maurizio Fornari; Scott C Robertson; Paulo Pereira; Mehmet Zileli; Carla D Anania; Ana Ferreira; Silvano Ferrari; Roberto Gatti; Francesco Costa Journal: World Neurosurg X Date: 2020-06-23