Surgical treatment of degenerative stenotic lesions of the lumbar spine. Own experience of using minimally invasive techniques




lumbar spinal stenosis, spondylolisthesis, stabilization, minimally invasive stabilization


Lumbar spinal stenosis is a multifactorial progressive condition mainly affecting older individuals, characterized by narrowing of the natural anatomical pathways passage of nerve structures, resulting in typical clinical symptoms. The disease affects about 103 million people in worldwide with an incidence of absolute lumbar spinal stenosis 19.4% among individuals aged 60-69 years. In the United States, about 600,000 surgical interventions for lumbar spinal stenosis are performed annually.

This disease is one of the most common causes of lumbar pain and lower limbs in the elderly individuals, accompanied by claudication and ultimately leading to disability. The main cause of clinical symptoms of the lumbar spinal stenosis is the discrepancy between the sizes of nerve structures and their osteofibrous sheaths, resulting from gradually developing degenerative-dystrophic changes.

Objective: To compare the outcomes of surgical treatment of patients with degenerative stenotic lesions of the lumbar spine using open and minimally invasive methods.

Materials and methods. The results of surgical treatment of 97 patients with lumbar spinal stenosis aged from 28 to 81 years on the basis of the Department of Minimally Invasive and Laser Spinal Neurosurgery of the State Institution " A.P. Romodanov Neurosurgery Institute, Ukraine", " Neurosurgical Department №20 of Vinnytsia Regional Clinical Psychoneurological Hospital named after Acad. O.I. Yushchenko" of Vinnytsia Regional Council and "Spinex" Medical Center following all clinical research protocols. Patients were divided into four groups depending on the surgical intervention method.

Results. The development of concepts regarding the mechanisms of occurrence and treatment methods of lumbar spinal stenosis are highlighted, as well as personal experience of using minimally invasive treatment techniques for this pathology in combination with the use of the ERAS (Enhanced Recovery After Surgery) protocol of perioperative patient management. It was found that the duration of hospital stay for patients with lumbar spinal stenosis statistically significantly desreased when using minimally invasive decompression (p≤0.05) and the ERAS rehabilitation protocol (p≤0.05). When comparing the average length of stay in the hospital of patients of the four groups, a statistically significant (p≤0.05) shorter length of stay in the hospital was observed for patients who underwent minimally invasive decompression using the ERAS rehabilitation protocol. The greatest reduction in pain intensity (according to the Numeric Pain Scale (NPS)) at 6 months post- intervention and rehabilitation was also noted in patients of this group.

Conclusions. The use of minimally invasive techniques, the correct choice of surgical procedure volume (interbody fusion is desirable in surgery for degenerative spinal diseases) combined with Enhanced Recovery after Surgery protocol (ERAS) significantly improves postoperative well-being of patients, accelerates patient mobilization, and reduces the length of stay in the hospital.


1. Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA. 2022 May 3;327(17):1688-1699. [CrossRef] [PubMed]

2. Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016 Jan 29;2016(1):CD010264. [CrossRef] [PubMed]

3. Komatsu J, Muta T, Nagura N, Iwabuchi M, Fukuda H, Kaneko K, Shirado O. Tubular surgery with the assistance of endoscopic surgery via a paramedian or midline approach for lumbar spinal canal stenosis at the L4/5 level. J Orthop Surg (Hong Kong). 2018 May-Aug;26(2):2309499018782546. [CrossRef] [PubMed]

4. Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, Hunter DJ. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. 2009 Jul;9(7):545-50. [CrossRef] [PubMed] [PubMed Central]

5. Yabuki S, Fukumori N, Takegami M, Onishi Y, Otani K, Sekiguchi M, Wakita T, Kikuchi S, Fukuhara S, Konno S. Prevalence of lumbar spinal stenosis, using the diagnostic support tool, and correlated factors in Japan: a population-based study. J Orthop Sci. 2013 Nov;18(6):893-900. [CrossRef] [PubMed] [PubMed Central]

6. Ishimoto Y, Yoshimura N, Muraki S, Yamada H, Nagata K, Hashizume H, Takiguchi N, Minamide A, Oka H, Kawaguchi H, Nakamura K, Akune T, Yoshida M. Prevalence of symptomatic lumbar spinal stenosis and its association with physical performance in a population-based cohort in Japan: the Wakayama Spine Study. Osteoarthritis Cartilage. 2012 Oct;20(10):1103-8. [CrossRef] [PubMed]

7. Verbiest H. Stenosis of the lumbar vertebral canal and sciatica. Neurosurg Rev. 1980;3(1):75-89. [CrossRef] [PubMed]

8. Verbiest H. A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg Br. 1954 May;36-B(2):230-7. [CrossRef] [PubMed]

9. Sachs B, Fraenkel J. Progressive ankylotic rigidity of the spine (spondylose rhizomélique). The Journal of Nervous and Mental Disease. 1900 Jan;27(1):1–15. [CrossRef]

10. Critchley EM. Lumbar spinal stenosis. Br Med J (Clin Res Ed). 1982 May 29;284(6329):1588-9. [CrossRef] [PubMed] [PubMed Central]

11. Clark K. Significance of the small lumbar spinal canal: cauda equina compression syndromes due to spondylosis. 2. Clinical and surgical significance. J Neurosurg. 1969 Nov;31(5):495-8. [CrossRef] [PubMed]

12. Getty CJ, Johnson JR, Kirwan EO, Sullivan MF. Partial undercutting facetectomy for bony entrapment of the lumbar nerve root. J Bone Joint Surg Br. 1981;63-B(3):330-5. [CrossRef] [PubMed]

13. Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010 Apr 7;303(13):1259-65. [CrossRef] [PubMed] [PubMed Central]

14. Martin BI, Tosteson ANA, Lurie JD, Mirza SK, Goodney PR, Dzebisashvili N, Goodman DC, Bronner KK. Variation in the Care of Surgical Conditions: Spinal Stenosis: A Dartmouth Atlas of Health Care Series [Internet]. Lebanon (NH): The Dartmouth Institute for Health Policy and Clinical Practice; 2014 Oct 28. [PubMed]

15. Knaub MA, Won DS, McGuire R, Herkowitz HN. Lumbar spinal stenosis: indications for arthrodesis and spinal instrumentation. Instr Course Lect. 2005;54:313-9. [PubMed]

16. Deyo RA. Treatment of lumbar spinal stenosis: a balancing act. Spine J. 2010 Jul;10(7):625-7. [CrossRef] [PubMed]

17. Akar E, Somay H. Comparative morphometric analysis of congenital and acquired lumbar spinal stenosis. J Clin Neurosci. 2019 Oct;68:256-261. [CrossRef] [PubMed]

18. Shiang R, Thompson LM, Zhu YZ, Church DM, Fielder TJ, Bocian M, Winokur ST, Wasmuth JJ. Mutations in the transmembrane domain of FGFR3 cause the most common genetic form of dwarfism, achondroplasia. Cell. 1994 Jul 29;78(2):335-42. [CrossRef] [PubMed]

19. Srikumaran U, Woodard EJ, Leet AI, Rigamonti D, Sponseller PD, Ain MC. Pedicle and spinal canal parameters of the lower thoracic and lumbar vertebrae in the achondroplast population. Spine (Phila Pa 1976). 2007 Oct 15;32(22):2423-31. [CrossRef] [PubMed]

20. Muthukumar N. Dural ossification in ossification of the ligamentum flavum: a preliminary report. Spine (Phila Pa 1976). 2009 Nov 15;34(24):2654-61. [CrossRef] [PubMed]

21. Zhou ZQ, Ota S, Deng C, Akiyama H, Hurlin PJ. Mutant activated FGFR3 impairs endochondral bone growth by preventing SOX9 downregulation in differentiating chondrocytes. Hum Mol Genet. 2015 Mar 15;24(6):1764-73. [CrossRef] [PubMed] [PubMed Central]

22. Yang Z, Xue Y, Zhang C, Dai Q, Zhou H. Surgical treatment of ossification of the ligamentum flavum associated with dural ossification in the thoracic spine. J Clin Neurosci. 2013 Feb;20(2):212-6. [CrossRef] [PubMed]

23. Fortin M, Lazáry À, Varga PP, Battié MC. Association between paraspinal muscle morphology, clinical symptoms and functional status in patients with lumbar spinal stenosis. Eur Spine J. 2017 Oct;26(10):2543-2551. [CrossRef] [PubMed]

24. Parker SL, Godil SS, Mendenhall SK, Zuckerman SL, Shau DN, McGirt MJ. Two-year comprehensive medical management of degenerative lumbar spine disease (lumbar spondylolisthesis, stenosis, or disc herniation): a value analysis of cost, pain, disability, and quality of life: clinical article. J Neurosurg Spine. 2014 Aug;21(2):143-9. [CrossRef] [PubMed]

25. Battié MC, Ortega-Alonso A, Niemelainen R, Gill K, Levalahti E, Videman T, Kaprio J. Lumbar spinal stenosis is a highly genetic condition partly mediated by disc degeneration. Arthritis Rheumatol. 2014 Dec;66(12):3505-10. [CrossRef] [PubMed] [PubMed Central]

26. Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016 Jan 4;352:h6234. [CrossRef] [PubMed] [PubMed Central]

27. Tomkins-Lane CC, Battié MC, Hu R, Macedo L. Pathoanatomical characteristics of clinical lumbar spinal stenosis. J Back Musculoskelet Rehabil. 2014;27(2):223-9. [CrossRef] [PubMed]

28. de Schepper EI, Overdevest GM, Suri P, Peul WC, Oei EH, Koes BW, Bierma-Zeinstra SM, Luijsterburg PA. Diagnosis of lumbar spinal stenosis: an updated systematic review of the accuracy of diagnostic tests. Spine (Phila Pa 1976). 2013 Apr 15;38(8):E469-81. [CrossRef] [PubMed]

29. Tomkins-Lane C, Melloh M, Lurie J, Smuck M, Battié MC, Freeman B, Samartzis D, Hu R, Barz T, Stuber K, Schneider M, Haig A, Schizas C, Cheung JPY, Mannion AF, Staub L, Comer C, Macedo L, Ahn SH, Takahashi K, Sandella D. ISSLS Prize Winner: Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis: Results of an International Delphi Study. Spine (Phila Pa 1976). 2016 Aug 1;41(15):1239-1246. [CrossRef] [PubMed] [PubMed Central]

30. Schönström N, Willén J. Imaging lumbar spinal stenosis. Radiol Clin North Am. 2001 Jan;39(1):31-53, v. [CrossRef] [PubMed]

31. Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, Kulik G. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976). 2010 Oct 1;35(21):1919-24. [CrossRef] [PubMed]

32. Weber C, Giannadakis C, Rao V, Jakola AS, Nerland U, Nygaard ØP, Solberg TK, Gulati S, Solheim O. Is There an Association Between Radiological Severity of Lumbar Spinal Stenosis and Disability, Pain, or Surgical Outcome?: A Multicenter Observational Study. Spine (Phila Pa 1976). 2016 Jan;41(2):E78-83. [CrossRef] [PubMed]

33. Yagci I, Gunduz OH, Ekinci G, Diracoglu D, Us O, Akyuz G. The utility of lumbar paraspinal mapping in the diagnosis of lumbar spinal stenosis. Am J Phys Med Rehabil. 2009 Oct;88(10):843-51. [CrossRef] [PubMed]

34. Ammendolia C, Stuber K, de Bruin LK, Furlan AD, Kennedy CA, Rampersaud YR, Steenstra IA, Pennick V. Nonoperative treatment of lumbar spinal stenosis with neurogenic claudication: a systematic review. Spine (Phila Pa 1976). 2012 May 1;37(10):E609-16. [CrossRef] [PubMed]

35. Phan K, Mobbs RJ. Minimally Invasive Versus Open Laminectomy for Lumbar Stenosis: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976). 2016 Jan;41(2):E91-E100. [CrossRef] [PubMed]

36. Bagley C, MacAllister M, Dosselman L, Moreno J, Aoun SG, El Ahmadieh TY. Current concepts and recent advances in understanding and managing lumbar spine stenosis. F1000Res. 2019 Jan 31;8:F1000 Faculty Rev-137. [CrossRef] [PubMed] [PubMed Central]

37. Kovacs FM, Urrútia G, Alarcón JD. Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine (Phila Pa 1976). 2011 Sep 15;36(20):E1335-51. [CrossRef] [PubMed]

38. Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, Fye M, Welch WC. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med. 2015 Apr 7;162(7):465-73. [CrossRef] [PubMed] [PubMed Central]

39. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H; SPORT Investigators. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008 Feb 21;358(8):794-810. [CrossRef] [PubMed] [PubMed Central]

40. Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976). 2010 Jun 15;35(14):1329-38. [CrossRef] [PubMed] [PubMed Central]

41. Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord. 1993 Dec;6(6):461-72. [CrossRef] [PubMed]

42. Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991 Jul;73(6):802-8. [PubMed]

43. Försth P, Michaëlsson K, Sandén B. Does fusion improve the outcome after decompressive surgery for lumbar spinal stenosis?: A two-year follow-up study involving 5390 patients. Bone Joint J. 2013 Jul;95-B(7):960-5. [CrossRef] [PubMed]

44. Försth P, Ólafsson G, Carlsson T, Frost A, Borgström F, Fritzell P, Öhagen P, Michaëlsson K, Sandén B. A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis. N Engl J Med. 2016 Apr 14;374(15):1413-23. [CrossRef] [PubMed]

45. Lønne G, Fritzell P, Hägg O, Nordvall D, Gerdhem P, Lagerbäck T, Andersen M, Eiskjaer S, Gehrchen M, Jacobs W, van Hooff ML, Solberg TK. Lumbar spinal stenosis: comparison of surgical practice variation and clinical outcome in three national spine registries. Spine J. 2019 Jan;19(1):41-49. [CrossRef] [PubMed]

46. Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, Coumans JV, Harrington JF, Amin-Hanjani S, Schwartz JS, Sonntag VK, Barker FG 2nd, Benzel EC. Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis. N Engl J Med. 2016 Apr 14;374(15):1424-34. [CrossRef] [PubMed]

47. Kepler CK, Vaccaro AR, Hilibrand AS, Anderson DG, Rihn JA, Albert TJ, Radcliff KE. National trends in the use of fusion techniques to treat degenerative spondylolisthesis. Spine (Phila Pa 1976). 2014 Sep 1;39(19):1584-9. [CrossRef] [PubMed]



How to Cite

Kapshuk, I. O., & Pedachenko, Y. E. (2024). Surgical treatment of degenerative stenotic lesions of the lumbar spine. Own experience of using minimally invasive techniques. Ukrainian Neurosurgical Journal, 30(1), 26–36.



Original articles