Lumbar Spinal Stenosis Requiring Decompression and Fusion

  • Ioannis Magras
  • Alkinoos Athanasiou
  • Vasiliki Magra


Stenosis and spinal instability due to lumbar degenerative disease is associated with aging and often requires surgical treatment to provide decompression, clinical improvement and stabilization. We present a 78-yo female patient, with neurological claudication, treated with laminectomy of L4 and fusion at t L4-L5 with screws and rods. With this case we would like to illustrate the decision making process in a patient with symptomatic stenosis and pathological hypermobility requiring fusion after the decompression. We discuss the indications and evidence in favor of fusion in cases where instability is manifest.


  1. 1.
    Covaro A, Vilà-Canet G, de Frutos AG, et al. Management of degenerative lumbar spinal stenosis: an evidence-based review. EFORT Open Rev. 2017;1(7):267–74. Scholar
  2. 2.
    Thomé C, Börm W, Meyer F. Degenerative lumbar spinal stenosis: current strategies in diagnosis and treatment. Dtsch Arztebl Int. 2008;105(20):373–9. Scholar
  3. 3.
    Försth P, Ólafsson G, Carlsson T, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 374(15):1413–23. Scholar
  4. 4.
    Willems PC, Staal JB, Walenkamp GH, et al. Spinal fusion for chronic low back pain: systematic review on the accuracy of tests for patient selection. Spine J. 2013;13(2):99–109.CrossRefGoogle Scholar
  5. 5.
    Kalff R, Ewald C, Waschke A, et al. Degenerative lumbar spinal stenosis in older people: current treatment options. Dtsch Arztebl Int. 2013;110(37):613–23 quiz 624. Scholar
  6. 6.
    Ghogawala Z, Dziura J, Butler WE, et al. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med. 2016;374(15):1424–34. Scholar
  7. 7.
    Rompe JD, Eysel P, Zöllner J, et al. Degenerative lumbar spinal stenosis. Long-term results after undercutting decompression compared with decompressive laminectomy alone or with instrumented fusion. Neurosurg Rev. 1999;22(2–3):102–6.CrossRefGoogle Scholar
  8. 8.
    Resnick DK, Choudhri TF, Dailey AT, et al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 10: fusion following decompression in patients with stenosis without spondylolisthesis. J Neurosurg Spine. 2005;2(6):686–91.CrossRefGoogle Scholar
  9. 9.
    Afathi M, Zairi F, Devos P, et al. Anterior lumbar sagittal alignment after anterior or lateral interbody fusion. Orthop Traumatol Surg Res. 2017;103(8):1245–50. Scholar
  10. 10.
    Umehara S, Zindrick MR, Patwardhan AG, et al. The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments. Spine (Phila Pa 1976). 2000;25(13):1617–24.CrossRefGoogle Scholar
  11. 11.
    Watters WC 3rd, Bono CM, Gilbert TJ, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J. 2009;9(7):609–14. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ioannis Magras
    • 1
  • Alkinoos Athanasiou
    • 1
  • Vasiliki Magra
    • 2
  1. 1.First Department of NeurosurgeryAHEPA University General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
  2. 2.Plastic Surgery DepartmentLister Hospital, East & North Hertfordshire NHS TrustHertfordshireUK

Personalised recommendations