• Pain Med · Dec 2019

    Review

    An Algorithmic Approach to Treating Lumbar Spinal Stenosis: An Evidenced-Based Approach.

    • Sudhir Diwan, Dawood Sayed, Timothy R Deer, Amber Salomons, and Kevin Liang.
    • Advanced Spine on Park Avenue, New York, NY 10022.
    • Pain Med. 2019 Dec 1; 20 (Suppl 2): S23-S31.

    ObjectiveLumbar spinal stenosis (LSS) can lead to compression of the neural and vascular elements and is becoming more common due to degenerative changes that occur because of aging processes. Symptoms may manifest as pain and discomfort that radiates to the lower leg, thigh, and/or buttocks. The traditional treatment algorithm for LSS consists of conservative management (physical therapy, medication, education, exercise), often followed by epidural steroid injections (ESIs), and when nonsurgical treatment has failed, open decompression surgery with or without fusion is considered. In this review, the variables that should be considered during the management of patients with LSS are discussed, and the role of each treatment option to provide optimal care is evaluated.ResultsThis review leads to the creation of an evidence-based practical algorithm to aid clinicians in the management of patients with LSS. Special emphasis is directed at minimally invasive surgery, which should be taken into consideration when conservative management and ESI have failed.© 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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