Minimally invasive surgery for lumbar spinal stenosis

Recent trends in spine surgery, such as endoscopic and other “micro” techniques, promised less invasive procedures and better outcomes compared with conventional open techniques for decompressing nerves. Minimally invasive techniques are popular with patients, promoted by industry, and increasingly used by surgeons.1 However, recent studies have failed to report any clear benefits for patients.2 Is our hunger for new techniques based on little more than a gut feeling that new and smaller is always better and, if so, is it ethically justifiable to “test” these new techniques on patients? In a linked paper (doi:10.1136/bmj.h1603) Nerland and colleagues provide some hard evidence to help inform these important debates.3

Their study compares the “old” standard surgical treatment for spinal stenosis (open laminectomy) with a newer and less invasive alternative (microdecompression). Microdecompression is a procedure to decompress the lumbar nerves by removing a minimal amount of bone and the ligamentum flavum but leaving the spinous process and the supraspinous and interspinous ligaments intact. The authors analyse data from a large, well organised and comprehensive national registry in Norway (the Norwegian Registry for Spine Surgery, NORspine). Thirty …