ReviewActa neurochirurgica2025
A narrative review and scoring proposal for secondary lumbar instability after lumbar decompression surgery.
Review in Acta neurochirurgica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Upright MRI Follow-Up for Decompression and Interlaminar Stabilization in Low-Grade L4/L5 Spondylolisthesis Suggests Reduced Reoperation Rates Compared With Fusion or Decompression Alone.International journal of spine surgery · 2026Article
- Interlaminar versus sublaminar lumbar decompression: a retrospective study on patient satisfaction as measured by PROMIS outcomes.Journal of spine surgery (Hong Kong) · 2026Article
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeLumbar spinal stenosis (LSS) is a common condition in the aging population, where decompressive surgery (DS) is widely regarded as the gold standard due to its effectiveness in relieving symptoms. However, DS carries the risk of secondary lumbar instability (SLI), while fusion surgery, although mitigating this risk, may lead to overtreatment and complications such as adjacent segment disease. The aim of the present study was to review the current literature on preoperative radiological and clinical variables, thus accounting for SLI after lumbar decompression surgery and to derive a score for SLI risk prediction.
methodsA literature review using online databases was performed in order to identify risk factors for the emergence of SLI. Risk factors were then graded for relevance. Consequently, a risk score for predicting SLI was developed from these results.
results25 studies including 9754 patients were identified. The most commonly described predictors for SLI were preoperative instability, disc height > 6.5 mm, surgical invasiveness as well as patient-related risk factors such as BMI, age, gender and presence of mechanical low back pain. Based on these results, a 14-point scale was created using the most relevant risk factors selected by the research group using a peer-review process.
conclusionThe proposed score identifies known risk factors for SLI, rated according to their importance on clinical decision making. This represents an initial theoretical approach that has to be validated by prospective clinical studies. Nevertheless, decision making may already be supported by the awareness of the characterized risk factors.
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