Indirect Decompression of Lumbar Stenosis

Abstract Degenerative lumbar stenosis can lead to symptoms of neurogenic claudication and lumbar radiculopathy. Lumbar stenosis can be caused by static compression of the neural elements in the central canal, along the lateral recess, and in the neuroforamen, as well as by dynamic changes to the total area of the central canal and neuroforamen. Previously, surgical options for the treatment of degenerative lumbar stenosis were primarily based on direct posterior open decompressions and fusions. However, novel techniques of indirect decompression have now been developed that restore disc height to increase the area of the central canal and neuroforamen and address the dynamic aspect of stenosis, while avoiding the extensive soft tissue injury involved in posterior open decompressions and fusions. Interbody fusions and interspinous devices are two methods of indirect decompression that are being commonly used. In this study, we provide a broad overview of the advantages, disadvantages, indications, evidence, and complications of ALIF, LLIF, and OLIF, as well as interspinous devices including Coflex. Though there is limited comparative evidence demonstrating that one approach is superior to another in terms of clinical and radiographic outcomes, evidence does show that interbody techniques are effective at treating lumbar stenosis by increasing the total area of the central canal and neuroforamen while having high fusion rates. Though the newer generation of interspinous devices have lower failure rates than their predecessors, they still are not comparable to the interbody devices in terms of long term outcomes. The optimal approach for the indirect treatment of lumbar stenosis therefore depends on multiple variables, including but not limited to the spinal level of disease, the anatomy of the individual patient, the pathology being treated, and the familiarity of the surgeon.