Clinical assessment and management of lumbar spinal stenosis: clinical dilemmas and considerations for surgical referral.

Lumbar spinal stenosis is the leading indication for spine surgery in older adults. Surgery is recommended in clinical guidelines if non-surgical treatments have been provided with insufficient benefit. The difficulty for clinicians is that the current number of randomised controlled trials is low, which creates uncertainty about which treatments to provide. For non-surgical clinicians this paucity of data leads to a clinical dilemma of whether to continue managing the patient or refer to a spine surgeon. This Viewpoint aims to provide an update on the assessment of lumbar spinal stenosis, treatment recommendations, indications for referral to a spine surgeon, and current clinical dilemmas facing non-surgical clinicians and spinal surgeons.
Competing Interests: Declaration of interests DJB holds an National Institute for Health and Care Research Senior Investigator award. FR receives payment or honoraria from Pierre Fabre, Thuasne, Institut Biochimique SA, Expanscience, Genevrier, Pfizer, MSD, Grunenthal, and Fidia Farmaceutici SpA.; has received support for attending meetings from The French Society of Physical and Rehabilitation Medicine, Osteoarthritis Research Society International, French Society of Rheumatology, AbbVie, and European Alliance of Associations for Rheumatology; participates on a data safety monitoring board and advisory board of Pierre Fabre and Thuasne; and holds leadership positions with The French Society of Physical and Rehabilitation Medicine (president elect), Osteoarthritis Research Society International (treasurer), and the Annals of Physical and Rehabilitation Medicine (associate editor). DJH provides consulting advice on scientific advisory boards for Pfizer, Lilly, Taiwan Liposome Company BioSciences, Novartis, Tissuegene, and Biobone; is the co-director of the Sydney Musculoskeletal Health Flagship; and is the editor of the osteoarthritis section for UpToDate and co-editor in chief of Osteoarthritis and Cartilage. All other authors declare no competing interests.
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