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Introduction This study aimed to investigate the perception of Korean medicine (KM) doctors regarding the treatment of degenerative lumbar spinal stenosis (LSS) and explore their opinions on the core clinical questions (CQs) of KM clinical practice guidelines (CPGs) for patients with degenerative LSS. Methods An online cross-sectional survey distributed via e-mail was conducted in December 2016. The study population included registered KM doctors (KMDs) in South Korea. The e-mail contained 13 questionnaire items regarding the doctors’ demographic characteristics and perceptions of the core CQs that should be addressed in CPGs for patients with degenerative LSS. Descriptive analyses were performed to summarize the data. Results A total of 680 KMDs responded to the survey. Kidney qi deficiency was the most commonly used diagnostic name for degenerative LSS. Acupuncture ranked first in the treatment used for degenerative LSS and in the treatment desired to be included in the development of CPG recommendations. Ojeok-san (积散, 積散, Wuji-san, Goshaku-san) was the number one herbal medicine, and 5% bee venom pharmacopuncture was the number one pharmacopuncture technique used for degenerative LSS. Drug therapy was the most selected control treatment considered appropriate to assess treatment effectiveness and safety. Pain relief was the most chosen indicator among the indicators considered reasonable to assess therapeutic effectiveness. Conclusion Results of this study are expected to inform the development of key CQs of the KM standard CPG for degenerative LSS. The involvement of KMDs in the CPG development process can help develop useful and available CPGs.

Degenerative lumbar spinal stenosis (LSS) and lumbar spondylolisthesis (DS) can lead to significant disability and impaired quality of life. In select patients with predominantly leg-dominant symptoms that have exhausted nonoperative treatment, surgical treatment can provide significant improvement in symptoms. The present paper reviews the clinical evaluation, radiographic findings, and surgical decision making of both spinal stenosis and degenerative spondylolisthesis using the current best available evidence.

The evidence-based clinical guideline on the diagnosis and treatment of degenerative lumbar spinal stenosis by the North American Spine Society (NASS) provides evidence-based recommendations to address key clinical questions surrounding the diagnosis and treatment of degenerative lumbar spinal stenosis. The guideline is intended to reflect contemporary treatment concepts for symptomatic degenerative lumbar spinal stenosis as reflected in the highest quality clinical literature available on this subject as of July 2010. The goals of the guideline recommendations are to assist in delivering optimum efficacious treatment and functional recovery from this spinal disorder.Provide an evidence-based educational tool to assist spine care providers in improving quality and efficiency of care delivered to patients with degenerative lumbar spinal stenosis.Systematic review and evidence-based clinical guideline.This report is from the Degenerative Lumbar Spinal Stenosis Work Group of the NASS's Evidence-Based Clinical Guideline Development Committee. The work group consisted of multidisciplinary spine care specialists trained in the principles of evidence-based analysis. The original guideline, published in 2006, was carefully reviewed. A literature search addressing each question and using a specific search protocol was performed on English language references found in MEDLINE, EMBASE (Drugs and Pharmacology), and four additional, evidence-based, databases to identify articles published since the search performed for the original guideline. The relevant literature was then independently rated by a minimum of three physician reviewers using the NASS-adopted standardized levels of evidence. An evidentiary table was created for each of the questions. Final recommendations to answer each clinical question were arrived at via work group discussion, and grades were assigned to the recommendations using standardized grades of recommendation. In the absence of Levels I to IV evidence, work group consensus statements have been developed using a modified nominal group technique, and these statements are clearly identified as such in the guideline.Sixteen key clinical questions were assessed, addressing issues of natural history, diagnosis, and treatment of degenerative lumbar spinal stenosis. The answers are summarized in this document. The respective recommendations were graded by the strength of the supporting literature that was stratified by levels of evidence.A clinical guideline for degenerative lumbar spinal stenosis has been updated using the techniques of evidence-based medicine and using the best available clinical evidence to aid both practitioners and patients involved with the care of this condition. The entire guideline document, including the evidentiary tables, suggestions for future research, and all references, will be available electronically at the NASS Web site (www.spine.org) and will remain updated on a timely schedule.

The U.S. population is living longer and staying increasingly more active. Symptoms of degenerative lumbar spinal stenosis are being seen with increasing frequency in older age groups. Many of the more symptomatic patients do not respond to nonoperative care and seek potential surgical solutions. The current article offers an evidence-based review of the literature for surgical treatment of degenerative lumbar spinal stenosis with a focus on the role of lumbar fusion. The author evaluates the evidence for surgical treatment of this condition so that appropriate, patient-centered care can be provided in the safest and most cost-effective manner possible.

Introduction/Background Degenerative lumbar spinal stenosis (DLSS) is a common source of pain and disability in the elderly population. Epidural steroid injections are often used to treat lumbosacral radiculopathy in DLSS. There is paucity of clinical trials comparing caudal epidural steroid injections plus local anaesthetics with conservative treatment. Moderate and high-quality evidence for nonoperative treatment is lacking and thus prohibits recommendations for guiding clinical practice. So, the aim of this study was to compare the effects of conservative treatment (physical therapy) and caudal epidural steroid injection with physical therapy in patients of DLSS (grade A and B). Material and method An Open Label, Parallel randomized controlled trial was conducted from January 2016–August 2017 and patients fulfilling the inclusion criteria were enrolled after written informed consent. The Trial was registered under the Clinical Trial Registry of India (CTRI). Patients were randomized in two groups–32 in Intervention Group A (caudal epidural steroid injection with physical therapy) and 32 in Control Group B (physical therapy only) with concealed allocation method. The outcome was assessed by Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), standing tolerance test and walking tolerance test at 3, 6, 12 and 24 weeks. Results Significant improvement in NPRS, ODI and standing tolerance test was observed at 3, 6 and 12 weeks (Group A > > Group B). Equivocal effect in NPRS and ODI was seen at 24 weeks (Group A ∼ Group B). Improvement in mean claudication distance was seen at each follow up from baseline (Group A > > Group B). The probability of improvement in intervention group (A) was more than in control group (B). Conclusion Epidural steroid administration improved pain, physical ability and claudication distance (> 200 meters) at 12 weeks aiding an early return to routine activities. Physical therapy also shows clinical improvement in patients of DLSS and can be an appropriate treatment modality.

COMMENTARY ON Kreiner DS, Shaffer WO, Baisden JL, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J 2013;13:734–43 ( in this issue ).

Nonoperative treatment for lumbar spinal stenosis must address anatomic and biomechanical factors. The entire functional kinetic chain and patient specific goals must be considered. In addition to passive modalities, manual therapy, and patient education, an active program consisting of flexion-based lumbar stabilization exercises, hip mobilization, proprioceptive training, and general conditioning should be initiated. More studies are needed to establish the benefit of a comprehensive, multifaceted treatment approach and to prove its clear benefit over the natural history of lumbar spinal stenosis.