Top Papers are articles in a specific subject rated by professionals and scholars in the field. Top 10 articles are displayed in an order from the most highest rating to the lowest. In order to rate an article, one must first register at as a member.

Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis.

Watters WC 3rd, Baisden J, Gilbert TJ, et al.

Spine J.  2008; 8: 305-310.

PubMed PMID: 18082461

This summary of NASS’s clinical guideline for degenerative stenosis addresses 18 clinical questions based on a rigorous review of the published evidence.  Regrettably the evidence available was often deemed insufficient or weak.  Nonetheless, this document should be the definitive starting point for reading about the treatment of stenosis.


Posted by on Nov 16, 2011 in Stenosis | 0 comments

Surgical Versus Nonoperative Treatment for Lumbar Spinal Stenosis Four-Year Results of the Spine Patient Outcomes Research Trial.

Weinstein JN, Tosteson TD, Lurie JD, et al.

Spine. 2010; 35: 1329-1338.

PMID: 20453723

The prospective, multicenter SPORT study included both randomized and observational cohorts treated surgically and nonoperatively for stenosis. The clinically significant benefits of surgery persisted for four years with greater initial pain relief than nonoperative treatment. This is the best clinical trial describing mid-term benefits of surgery for stenosis.


Posted by on Nov 16, 2011 in Stenosis | 0 comments

Spinal stenosis surgery in Sweden 1987-1999.

Jansson KA, Blomqvist P, Granath F, Németh G.

Eur Spine J. 2003; 12: 535-541.

PMID: 12768381

This population-based registry study tracked over 10,000 patients operated on during 1987-1999. The procedure rate increased from 4.7 to 13.2 per 100,000 inhabitants annually, with 30-day mortality of 0.35%. By capturing all stenosis surgeries in Sweden for over a decade, this paper provides a unique comprehensive epidemiological overview.


Posted by on Nov 16, 2011 in Stenosis | 0 comments

Morbidity and mortality in the surgical treatment of 10,329 adults with degenerative lumbar stenosis.

Fu KM, Smith JS, Polly DW Jr, et al.

J Neurosurg Spine. 2010; 12: 443-446.

PMID: 20433290

This report presents the incidence of complications from surgery in a registry with over 10,000 stenosis patients. The overall complication rate was 7% for decompression with or without fusion, and rates of specific complication types are presented. This study provides a definitive complication rate for counseling patients.


Posted by on Nov 16, 2011 in Stenosis | 0 comments

Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar Spinal Stenosis in Older Adults.

Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG.

JAMA. 2010; 303: 1259-1265.

PMID: 20371784

This retrospective analysis of Medicare claims from 2002-2007 documented an inflation-adjusted 40% increase in hospital charges. While surgeons performed fewer decompressions and simple fusions, complex fusion procedures multiplied 15-fold and increased the complications, mortality, and costs. This paper alerts the surgical community to important negative changes in practice patterns.


Posted by on Nov 16, 2011 in Stenosis | 0 comments

Predominant Leg Pain Is Associated With Better Surgical Outcomes in Degenerative Spondylolisthesis and Spinal Stenosis: Results From the Spine Patient Outcomes Research Trial (SPORT).

Pearson A, Blood E, Lurie J, Abdu W, Sengupta D, Frymoyer JW, Weinstein J.

Spine.  2011; 36: 219-229.

PMID: 21124260

This post hoc analysis from the SPORT study compared two-year outcomes of stenosis patients (both with and without spondylolisthesis) stratified by predominant pain location. Patients with predominant leg pain were most likely to show improvement, especially if treated surgically. This study provides a useful insight for pre-operative counseling.


Posted by on Nov 16, 2011 in Stenosis | 0 comments

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.

Resnick DK, Choudhri TF, Dailey AT, et al.

J Neurosurg Spine. 2005; 2: 686-691.

PMID: 16028738

This paper provides treatment guidelines for stenosis without spondylolisthesis based on a review of 26 level-III studies. Fusion is recommended in addition to decompression only when pre-existing or iatrogenic instability is present. This AANS/CNS guideline provides the best recommendations for surgeons considering fusion or supplemental instrumentation for stenosis.


Posted by on Nov 16, 2011 in Stenosis | 0 comments

Long-Term Outcomes of Surgical and Nonsurgical Management of Lumbar Spinal Stenosis: 8 to 10 Year Results from the Maine Lumbar Spine Study.

Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE.

Spine. 2005; 30: 936-943.

PMID: 15834339

This prospective observational cohort study tracked 105 stenosis patients for at least eight years following surgical or non-operative treatment. Although the measured outcomes favored surgery for four years, the benefits over nonoperative therapy disappeared by ten years. This study provides the best long-term clinical results of surgery for stenosis.


Posted by on Nov 16, 2011 in Stenosis | 0 comments

Lumbar spinal stenosis: syndrome, diagnostics and treatment.

Siebert E, Prüss H, Klingebiel R, Failli V, Einhäupl KM, Schwab JM.

Nat Rev Neurol. 2009; 5: 392-403.

PMID: 19578346

This narrative review of stenosis covers pathophysiology, symptoms, diagnosis, and therapy. This paper provides good comparisons of the benefits and limitations of various imaging modalities.  The full range or treatment possibilities is briefly presented along with the corresponding evidence. This paper is probably the best concise broad overview of stenosis.


Posted by on Nov 16, 2011 in Stenosis | 0 comments

The Increasing Morbidity of Elective Spinal Stenosis Surgery: Is It Necessary?

Carragee EJ.

JAMA. 2010; 303: 1309-1310.

PMID: 20371793

This editorial reports concern over the increase in surgical complications for stenosis. Complication rates rose from negligible levels in 2002 to 15% in 2007; the author attributes this change to increased procedural complexity for higher reimbursement. This thought-provoking piece sheds light on systematic trends that may affect patient care.


Posted by on Nov 16, 2011 in Stenosis | 0 comments