Decompression Surgery
What the Guidelines Recommend (Clinical Practice Guidelines 2021)
The Japanese Clinical Practice Guidelines for Lumbar Spinal Stenosis (2021, 2nd edition) recommend the following for decompression:
| Recommendation | Grade | Evidence Level |
|---|---|---|
| Decompression surgery has been shown to produce favorable outcomes in multiple studies. For LSS without instability where conservative treatment has not been effective, decompression surgery is recommended. | 2 (Suggested) | B |
Key points from the guidelines:
- Conservative treatment is recommended as the initial approach, but prolonged conservative treatment should be avoided in severe cases (including from a cost-effectiveness standpoint)
- For LSS without instability or deformity, outcomes at 2 years favor surgery over conservative treatment
- The difference between surgery and conservative treatment narrows after 2 years over time
- The possibility of surgical complications must be explained to patients before surgery
What this means for you:
The guidelines tell us that surgery is not a cure-all, but it is effective when performed on the right patient at the right time. The key points to remember are:
- Decompression works best when there is no instability (no slippage or excessive movement)
- Surgery should be considered after conservative treatment has been given a fair trial
- However, in severe cases, you should not continue ineffective conservative treatment indefinitely