Minimally Invasive Decompression in Lumbar Spinal Stenosis.

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Abstract

13. Nervenarzt. 2018 Jun;89(6):639-647. doi: 10.1007/s00115-018-0523-3. [Operative treatment of degenerative diseases of the lumbar spine]. [Article in German] Czabanka M(1), Thomé C(2), Ringel F(3), Meyer B(4), Eicker SO(5), Rohde V(6), Stoffel M(7), Vajkoczy P(1). Author information: (1)Klinik und Poliklinik für Neurochirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland. (2)Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich. (3)Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Deutschland. (4)Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, München, Deutschland. (5)Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland. (6)Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland. (7)Klinik für Neurochirurgie, Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Deutschland. michael.stoffel@helios-gesundheit.de. BACKGROUND: Degenerative diseases of the lumbar spine and associated lower back pain represent a major epidemiological and health-related economic challenge. A distinction is made between specific and unspecific lower back pain. In specific lower back pain lumbar disc herniation and spinal canal stenosis with or without associated segment instability are among the most frequent pathologies. Diverse conservative and operative strategies for treatment of these diseases are available. OBJECTIVES: The aim of this article is to present an overview of current data and an evidence-based assessment of the possible forms of treatment. MATERIAL AND METHODS: An extensive literature search was carried out via Medline plus an additional evaluation of the authors' personal experiences. RESULTS: Conservative and surgical treatment represent efficient treatment options for degenerative diseases of the lumbar spine. Surgical treatment of lumbar disc herniation shows slight advantages compared to conservative treatment consisting of faster recovery of neurological deficits and a faster restitution of pain control. Surgical decompression is superior to conservative measures for the treatment of spinal canal stenosis and degenerative spondylolisthesis. In this scenario conservative treatment represents an important supporting measure for surgical treatment in order to improve the mobility of patients and the outcome of surgical treatment. CONCLUSION: The treatment of specific lower back pain due to degenerative lumbar pathologies represents an interdisciplinary challenge, requiring both conservative and surgical treatment strategies in a synergistic treatment concept in order to achieve the best results for patients. DOI: 10.1007/s00115-018-0523-3