Lumbar Spinal Stenosis

  • Ioannis Magras
  • Alkinoos Athanasiou
  • Vasiliki Magra


Stenosis due to lumbar degenerative disease is associated with aging and often requires surgical treatment to provide decompression of the neural elements and alleviation of the symptoms. We present an 83-yo female patient, with neurological claudication and bilateral L5 paresis, treated with undercutting and bilateral flavectomy at the level L4-L5 without fusion. With this case we would like to illustrate the decision-making problem for or against fusion and the operative approach for adequate decompression without causing further instability. We discuss the indications of undercutting and the evidence against routinely performing fusion and compare our presentation to the current literature.


  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.
    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
  3. 3.
    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
  4. 4.
    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
  5. 5.
    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
  6. 6.
    Försth P, Ólafsson G, Carlsson T, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016;374(15):1413–23. Scholar
  7. 7.
    Guigui P, Delecourt C, Delhoume J, et al. Severe motor weakness associated with lumbar spinal stenosis. A retrospective study of a series of 61 patients. Rev Chir Orthop Reparatrice Appar Mot. 1997;83(7):622–8. [Article in French].PubMedGoogle Scholar
  8. 8.
    Jönsson B, Strömqvist B. Motor affliction of the L5 nerve root in lumbar nerve root compression syndromes. Spine (Phila Pa 1976). 1995;20(18):2012–5.CrossRefGoogle Scholar
  9. 9.
    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
  10. 10.
    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

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