La stenosi del canale vertebrale lombare: il trattamento stabilizzante decompressivo
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Patients with lumbar spinal stenosis may be treated non-operatively or surgically by decompression alone or by decompression with instrumentation (fusion or not fusion). Preservation of spinal stability is critical to prevent late failure. To avoid iatrogenic instability is mandatory to maintain facet joint integrity by undercutting them instead of excision. When spinal stenosis is associated with instability, degenerative spondylolisthesis, deformity, postoperative instability, or recurrent stenosis, intervertebral instrumented fusion is recommended. Elderly patients aged over 70 years benefit from lumbar decompression and posterolateral fusion with instrumentation and there is no need to force an intersomatic fusion with the related surgical complications. The indirect decompression techniques have still not yet had widespread consensus and they need further randomized controlled trials.
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