Best Practices for Minimally Invasive Lumbar Spinal Stenosis Treatment 2.0 (MIST): Consensus Guidance from the American Society of Pain and Neuroscience (ASPN)

• Published in: Journal of pain research Vol. 15; pp. 1325 - 1354
• Main Authors: Deer, Timothy R, Grider, Jay S, Pope, Jason E, Lamer, Tim J, Wahezi, Sayed E, Hagedorn, Jonathan M, Falowski, Steven, Tolba, Reda, Shah, Jay M, Strand, Natalie, Escobar, Alex, Malinowski, Mark, Bux, Anjum, Jassal, Navdeep, Hah, Jennifer, Weisbein, Jacqueline, Tomycz, Nestor D, Jameson, Jessica, Petersen, Erika A, Sayed, Dawood
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2022; Dove; Dove Medical Press
• Subjects: Associations, institutions, etc; Care and treatment; epidural steroid injections; Evidence-based medicine; interspinous spacers; intrathecal drug delivery; Medicine, Preventive; Nervous system; Neurosciences; neurostimulation; open decompression; Patients; percutaneous image-guided lumbar decompression; Preventive health services; Review; Societies; Spinal canal; Stenosis; Surgery; Task forces; open decompression; interspinous spacers; epidural steroid injections; intrathecal drug delivery; neurostimulation; percutaneous image-guided lumbar decompression
• ISSN: 1178-7090; 1178-7090
• DOI: 10.2147/JPR.S355285

Lumbar spinal stenosis (LSS) is a common spinal disease of aging with a growing patient population, paralleling population growth. Minimally invasive treatments are evolving, and the use of these techniques needs guidance to provide the optimal patient safety and efficacy outcomes. The American Society of Pain and Neuroscience (ASPN) identified an educational need for guidance on the prudent use of the innovative minimally invasive surgical therapies for the treatment of symptomatic LSS. The executive board nominated experts spanning anesthesiology, physiatry, orthopedic surgery, and neurosurgery based on expertise, publications, research, diversity and field of practice. Evidence was reviewed, graded using the United States Preventive Services Task Force (USPSTF) criteria for evidence and recommendation strength and grade, and expert opinion was added to make consensus points for best practice. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for LSS-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using USPSTF criteria and consensus points are presented. The algorithm for patient selection in the management of symptomatic spinal stenosis is evolving. Careful consideration of patient selection and anatomic architecture variance is critical for improved outcomes and patient safety. ASPN created a guidance for best practice for minimally invasive surgical treatment of symptomatic spinal stenosis.