GUIDELINES   Free access

Journal of Neurosurgical Sciences 2021 April;65(2):91-100

DOI: 10.23736/S0390-5616.20.05042-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Degenerative Lumbar Spine Stenosis Consensus Conference: the Italian job. Recommendations of the Spinal Section of the Italian Society of Neurosurgery

Francesco COSTA ^{1, 2} ✉, Gualtiero INNOCENZI ³, Franco GUIDA ⁴, Umberto AGRILLO ⁵, Giuseppe BARBAGALLO ⁶, Antonio BOCCHETTI ⁷, Daniele BONGETTA ⁸, Barbara CAPPELLETTO ⁹, Francesco CERTO ⁶, Marco CIMATTI ¹⁰, Valentina CIOFFI ⁷, Mauro DOBRAN ¹¹, Maurizio DOMENICUCCI ¹², Giancarlo GUIZZARDI ¹³, Giulia GUIZZARDI ¹⁴, Alessandro LANDI ¹⁵, Nicola MAROTTA ¹⁵, Francesco MARZETTI ¹⁶, Nicola MONTANO ¹⁷, Carla D. ANANIA ¹, Pierpaolo NINA ¹⁸, Paolo QUAGLIETTA ¹⁹, Rossella RISPOLI ⁹, Teresa SOMMA ¹⁴, Eleonora SQUILLANTE ¹⁸, Massimiliano VISOCCHI ¹⁷, Matteo VITALI ²⁰, Vincenzo VITIELLO ¹⁸

¹ Department of Neurosurgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy; ² Department of Biomedical Sceinces, Humanitas University, Milan, Italy; ³ Department of Neurosurgery, IRCCS NEUROMED, Pozzilli, Isernia, Italy; ⁴ Department of Neurosurgery, Ospedale dell’Angelo, Mestre, Venice, Italy; ⁵ Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy; ⁶ Department of Neurosurgery, University of Catania, Catania, Italy; ⁷ Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, Pozzuoli, Naples, Italy; ⁸ Department of Neurosurgery, ASST Fatebenefratelli Sacco, Milan, Italy; ⁹ Section of Spinal Column and Spinal Cord Surgery and Spinal Unit, Santa Maria della Misericordia University Hospital, Udine, Italy; ¹⁰ N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy; ¹¹ Department of Neurosurgery, Marche Polytechnic University, Ancona, Italy; ¹² Department of Neurology and Psychiatry, Neurosurgery, Polo Pontino, Sapienza University, Rome, Italy; ¹³ Spinal Section, Centro Chirurgico Toscano, Arezzo, Italy; ¹⁴ Division of Neurosurgery, Federico II University, Naples, Italy; ¹⁵ Division of Neurosurgery and Spinal Surgery, San Carlo di Nancy Hospital, Rome, Italy; ¹⁶ Neurosurgery Division, Umberto I University Hospital, Sapienza University, Rome, Italy; ¹⁷ Institute of Neurosurgery, Catholic University of Rome, Rome, Italy; ¹⁸ Unit of Neurosurgery, San Giovanni Bosco Hospital, Naples, Italy; ¹⁹ Unit of Neurosurgery, General Hospital of Cosenza, Cosenza, Italy; ²⁰ Unit of Neurosurgery, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy

In the modern era evidence-based medicine, guidelines and recommendations represent a key-point of daily activity. The Spinal Section of the Italian Society of Neurosurgery introduced some recommendations regarding Degenerative Lumbar Spine Stenosis based on those of the Spine Committee of World Federation of Neurosurgical Societies, revising them on the basis of Italian common practice. In June 2019, a Committee of 21 spine surgeons met in Rome to validate the recommendations of the WFNS. Furthermore, they decided to review the ones that did not reach a consensus to create Italian Recommendations on Degenerative Lumbar Spine Stenosis. A literature review of the last ten years was performed and the statements were voted using the Delphi method. Forty-one statements were discussed, and 7 statements were voted again to reach a consensus with respect to those of the WFNS. A total of 40 statements reached a consensus, of which 36 reached a positive consensus and 4 a negative consensus, while no consensus was reached in 1 case. Conservative multimodal therapy, tailored on the patient, is a reasonable and effective first option choice for the treatment of LSS patients with tolerable moderate symptoms. Surgical treatment is reserved for symptomatic patients non-responding to conservative treatment or with neurological deficits. The best surgical technique to use depends on personal experience; modern MISS techniques are equivalent to open decompressive surgery with some advantages and higher cost-effectiveness. Fusion surgery and mobility preserving surgery only have a marginal role in the treatment of DLSS without instability.

KEY WORDS: Lumbar vertebrae; Health planning guidelines; Guidelines