Deer Timothy R, Grider Jay S, Pope Jason E, Lamer Tim J, Wahezi Sayed E, Hagedorn Jonathan M, Falowski Steven, Tolba Reda, Shah Jay M, Strand Natalie, Escobar Alex, Malinowski Mark, Bux Anjum, Jassal Navdeep, Hah Jennifer, Weisbein Jacqueline, Tomycz Nestor D, Jameson Jessica, Petersen Erika A, Sayed Dawood
Centers for Pain Relief, Charleston, WV, USA.
UK HealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA.
J Pain Res. 2022 May 5;15:1325-1354. doi: 10.2147/JPR.S355285. eCollection 2022.
Lumbar spinal stenosis (LSS) is a common spinal disease of aging with a growing patient population, paralleling population growth. Minimally invasive treatments are evolving, and the use of these techniques needs guidance to provide the optimal patient safety and efficacy outcomes.
The American Society of Pain and Neuroscience (ASPN) identified an educational need for guidance on the prudent use of the innovative minimally invasive surgical therapies for the treatment of symptomatic LSS. The executive board nominated experts spanning anesthesiology, physiatry, orthopedic surgery, and neurosurgery based on expertise, publications, research, diversity and field of practice. Evidence was reviewed, graded using the United States Preventive Services Task Force (USPSTF) criteria for evidence and recommendation strength and grade, and expert opinion was added to make consensus points for best practice.
The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for LSS-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using USPSTF criteria and consensus points are presented.
The algorithm for patient selection in the management of symptomatic spinal stenosis is evolving. Careful consideration of patient selection and anatomic architecture variance is critical for improved outcomes and patient safety.
ASPN created a guidance for best practice for minimally invasive surgical treatment of symptomatic spinal stenosis.
腰椎管狭窄症（LSS）是一种常见的与衰老相关的脊柱疾病，随着人口增长，患者数量也在不断增加。微创治疗方法不断发展，这些技术的应用需要指导，以确保患者获得最佳的安全性和疗效。
美国疼痛与神经科学学会（ASPN）确定了一项教育需求，即需要为谨慎使用创新的微创外科治疗方法来治疗有症状的LSS提供指导。执行委员会根据专业知识、出版物、研究、多样性和实践领域，提名了来自麻醉学、物理医学与康复、骨科手术和神经外科的专家。对证据进行了审查，使用美国预防服务工作组（USPSTF）的证据和推荐强度及等级标准进行分级，并加入专家意见以形成最佳实践的共识点。
使用Medline、EMBASE、Cochrane CENTRAL、BioMed Central、Web of Science、Google Scholar、PubMed、Current Contents Connect、Scopus和会议摘要搜索了英文的世界文献，以识别和汇编与LSS相关疼痛的证据（按章节）。根据所代表的章节选择搜索词。使用USPSTF标准对已识别的同行评审文献进行了批判，并列出了共识点。
有症状的椎管狭窄症管理中患者选择的算法正在不断发展。仔细考虑患者选择和解剖结构差异对于改善治疗效果和患者安全至关重要。
ASPN制定了有症状椎管狭窄症微创外科治疗的最佳实践指南。
