Medical Student Idaho College of Osteopathic Medicine Helena, Montana
Background and/or Objectives: Lumbar spinal stenosis (LSS) is a common degenerative spine condition and a leading cause of disability in older adults. Treatment options range from conservative management to surgical decompression, with minimally invasive spine interventions (MISI) emerging as alternatives aimed at reducing morbidity. This review compares long-term outcomes between MISI and surgical decompression in LSS to guide evidence-based treatment decisions.
Design: Systematic literature review of randomized controlled trials, cohort studies, and meta-analyses reporting long-term outcomes (≥2 years) of MISI versus surgical decompression.
Setting : Studies were identified across databases including PubMed, Cochrane Library, and Embase, focusing on outpatient and inpatient spine care settings.
Participants : Adults diagnosed with lumbar spinal stenosis confirmed via clinical and radiographic criteria.
Interventions: MISI techniques included epidural steroid injections, interspinous devices, radiofrequency ablation, and minimally invasive decompression. Surgical comparators included open laminectomy, instrumented fusion, and laminoplasty.
Main Outcome Measures: Pain scores (e.g., VAS), functional outcomes (e.g., Oswestry Disability Index), quality of life (e.g., SF-36), reoperation rates, complication rates, and cost-effectiveness.
Results: Both MISI and surgical decompression yielded meaningful short-term improvements in pain and function. Surgical decompression showed superior early outcomes, especially in patients receiving fusion, though benefits diminished after 2–4 years. MISI was associated with faster recovery, fewer perioperative complications, and higher reoperation rates. Long-term functional and QoL outcomes were comparable in many cases.
Conclusions: MISI and surgical decompression each offer advantages in treating LSS, but the evidence is limited by a lack of robust long-term follow-up studies, particularly those evaluating quality of life. More high-quality, longitudinal research is needed to determine definitive statistical conclusions regarding the optimal long-term strategy for managing LSS.
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