Minimally invasive lumbar decompression for the treatment of spinal stenosis of the lumbar spine

AAPT Diagnostic Criteria for Chronic Low Back Pain

Chronic low back pain (CLBP) conditions are highly prevalent and constitute the leading cause of disability worldwide. The Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the US Food and Drug Administration and the American Pain Society (APS), have combined to create the ACTTION-APS Pain Taxonomy (AAPT). The AAPT initiative convened a working group to develop diagnostic criteria for CLBP. The working group identified 3 distinct low back pain conditions which result in a vast public health burden across the lifespan. This article focuses on: 1) the axial predominant syndrome of chronic musculoskeletal low back pain, 2) the lateralized, distally-radiating syndrome of chronic lumbosacral radicular pain 3) and neurogenic claudication associated with lumbar spinal stenosis. This classification of CLBP is organized according to the AAPT multidimensional framework, specifically 1) core diagnostic criteria; 2) common features; 3) common medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors. PERSPECTIVE: An evidence-based classification of CLBP conditions was constructed for the AAPT initiative. This multidimensional diagnostic framework includes: 1) core diagnostic criteria; 2) common features; 3) medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.

Minimally invasive lumbar decompression: a treatment for lumbar spinal stenosis

PURPOSE OF REVIEW

Percutaneous lumbar decompression is a minimally invasive procedure for the treatment of symptomatic lumbar spinal stenosis (LSS). The purpose of this article is to review the current literature on percutaneous lumbar decompression as well as review the safety and outcomes associated with the procedure.

RECENT FINDINGS

LSS is a significant cause of chronic pain and a common indication for invasive spine surgery. The recent literature shows that percutaneous lumbar decompression is a minimally invasive treatment option that affords a high level of safety, improved function, decreased pain scores, and is cost-effective.

SUMMARY

This minimally invasive procedure is an option for patients with central canal LSS who have continued pain-following conservative treatment such as physical therapy, oral medications, and lumbar spine injections. Percutaneous lumbar decompression is a procedure that bridges the gap between invasive surgery and more conservative treatment for LSS. This percutaneous technique provides increasing options to those patients with central canal lumbar stenosis who may not be candidates for an invasive decompression procedure. Overall, this procedure has been found to be well tolerated and effective in reducing pain while generally improving function.