Lumbar Spinal Stenosis · Conservative vs Decompression ± Fusion

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Cauda equina? + claudication/course + instability
   Cauda equina? Neurogenic claudication/course? Segmental instability/spondylolisthesis?
   • Cauda equina syndrome → Cauda equina → emergency decompression
   • Neurogenic claudication, no major deficit, not adequately treated conservatively → Claudication → conservative 3–6 months
   • Conservative 3–6 months failed or significantly disabling/progressive deficit, no instability → Conservative failed → spinal decompression
   • Associated segmental instability/degenerative spondylolisthesis (with instability)/deformity → Instability/spondylolisthesis → decompression + fusion
2. [End] Cauda equina → emergency decompression
   Cauda equina syndrome → emergency MRI + decompression surgery as soon as possible.
3. [End] Claudication → conservative 3–6 months
   Neurogenic claudication, no major deficit → conservative for 3–6 months: physiotherapy, NSAIDs, activity modification, epidural steroid injection.
4. [End] Conservative failed → spinal decompression
   Conservative failure/significantly disabling/progressive, no segmental instability → spinal decompression (laminectomy/laminoplasty/limited decompression); no routine fusion without instability.
5. [End] Instability/spondylolisthesis → decompression + fusion
   Associated segmental instability/degenerative spondylolisthesis with instability/deformity, or iatrogenic instability from wide decompression → decompression + fusion.

Source guidelines & references

• Lumbar spinal stenosis management (NASS guideline; SPORT/Forsth/SLIP evidence on decompression ± fusion)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways