Spinal stenosis — master index¶
Last curated: 2026-10-26 · status: sweep pending independent audit · 16 curated and 2 draft wiki pages · 358-paper master bibliography · 6 landmark notes · 24-document guideline registry · >100 sourced statistics rows · 8 previously verified organizations · 26 open questions + 14 unconnected-dots junctions
The condition in five sentences. Spinal stenosis becomes a clinical disorder when central-canal, lateral-recess or foraminal narrowing produces a concordant neural syndrome; imaging-only narrowing is common, including a pooled 11% (95% CI 5–18%) radiological prevalence in asymptomatic samples (Jensen 2020, PMID 32095908). Lumbar disease is dominated by posture-dependent neurogenic claudication and loss of walking, while cervical cord compression can produce progressive hand dysfunction, gait imbalance, long-tract signs and falls. Moderate lumbar symptoms often remain stable—leg pain worsened in 13% and only 7% crossed to surgery over 3.3 years in one cohort—whereas modeled neurological stability in mild DCM fell from 91% at one year to 75% at five years (Wessberg 2017, PMID 28417234; Sarraj 2024, PMID 37549831). Multimodal rehabilitation is the best-supported first lumbar strategy for stable disease; decompression helps selected persistent disabling cases, but epidural steroid adds little over anesthetic and fusion adds no routine disability benefit for many patients with degenerative spondylolisthesis (Friedly 2014, PMID 24988555; Austevoll 2021, PMID 34347953; Kgomotso 2024, PMID 39111800). Progressive DCM and cauda-equina dysfunction are the safety-critical exceptions, and the central research problem across phenotypes is predicting individual benefit and deterioration from clinical pattern, objective function and anatomy rather than scan severity alone.
Start here: overview.md. Frontier: OPEN-QUESTIONS.md. Growth history: LOG.md. Deliberate sibling boundary: degenerative disc disease covers discogenic axial pain and structural disc change; this condition covers neural compression syndromes.
Reading paths¶
- Lumbar clinical path — overview → lumbar phenotype → diagnosis → rehabilitation → injections/procedures → decompression → fusion question
- Cervical cord path — cervical stenosis and myelopathy → diagnosis → cervical surgery → frailty/perioperative risk → safety
- Measurement and science path — anatomy/imaging → outcomes/walking → biomarkers/digital mobility → trials landscape
- Evidence-governance path — guidelines → guideline registry → statistics → bibliography
- Human and unknowns path — patient experience → patient-voice themes → open questions
Pages¶
| Section | File | Scope | Status |
|---|---|---|---|
| Foundations | overview.md | Lumbar/cervical phenotypes, diagnosis and treatment map | curated |
| Foundations | anatomy-classification-and-imaging.md | Central, lateral recess, foraminal stenosis and measurement limits | curated |
| Foundations | epidemiology-and-natural-history.md | Definition-stratified prevalence, trajectories, progression and burden | curated |
| Lumbar | lumbar-stenosis-and-neurogenic-claudication.md | Classic phenotype, walking limitation and boundary conditions | curated |
| Cervical | cervical-stenosis-and-myelopathy.md | Cord compression, myelopathic signs, progression and timing | draft |
| Clinical | diagnosis-and-differential.md | History, neurological examination, vascular claudication and mimics | curated |
| Clinical | conservative-and-rehabilitation-care.md | Education, exercise, manual therapy, medicines and walking programs | curated |
| Clinical | injections-and-minimally-invasive-procedures.md | Epidural injection, percutaneous decompression and devices | curated |
| Lumbar surgery | lumbar-decompression.md | Indications, techniques, outcomes, recurrence and complications | curated |
| Lumbar surgery | decompression-versus-fusion.md | Instability/spondylolisthesis, randomized trials and reoperation | curated |
| Cervical surgery | cervical-decompression-and-fusion.md | Anterior/posterior strategies and myelopathy outcomes | curated |
| Perioperative | older-adults-frailty-and-perioperative-risk.md | Frailty, cognition, bone health, delirium and shared decisions | curated |
| Measurement | outcomes-and-walking-measurement.md | ODI, Zurich scale, mJOA, objective walking and patient priorities | curated |
| Guidance | guidelines.md | NASS, WFNS, NICE, Japanese and DCM recommendations | draft |
| Frontier | biomarkers-and-digital-mobility.md | Gait, imaging, fluid and predictive candidates | curated |
| Frontier | clinical-trials-landscape.md | Rehabilitation, procedures, surgery and device trials | curated |
| Human | patient-experience-and-advocacy.md | Mobility loss, falls, waiting, information and access | curated |
| Safety | red-flags-and-safety-concerns.md | Cauda equina, progressive myelopathy, falls, infection and deterioration | curated |
Literature layer¶
| Artifact | Contents |
|---|---|
| BIBLIOGRAPHY.md | 358 papers with topic and cited-by mapping; two added in the 2026-10-26 sweep |
| notes/ | Six landmark notes: prevalence, epidural trial, SPORT, Swedish fusion trial, NORDSTEN-DS and DCM guideline |
| guidelines/REGISTRY.md | 24 documents/modules across NASS, WFNS, Italy, Japan, AO Spine/CSRS, ACR, AAN, MIST, ISSLS and NICE; succession and disagreements |
| statistics/STATISTICS.md | >100 population-, method- and comparator-specific rows plus eight caveats/conflicts |
| patient-voice/README.md | Method, ethics and coverage limits |
| patient-voice/organizations.md | Eight organizations fetched live across six regional groupings |
| patient-voice/themes.md | Eight aggregate themes, each supported by at least two sources |
| patient-voice/sources.md | Annotated qualitative, quantitative and public-source ledger |
Curation state¶
The condition passed a full independent audit on 2026-08-30. At that audit, all 18 planned pages were status: curated; 350 unique PMIDs were re-fetched through PubMed E-utilities, all eight displayed NCT records were re-fetched individually through ClinicalTrials.gov API v2, and page references were reconciled to the master bibliography. ClinicalTrials.gov coverage remains a dated snapshot: condition queries returned 414 records for lumbar spinal stenosis and 57 for degenerative cervical myelopathy on 2026-08-30. The absence searches and their dated, positively stated evidence gaps remain in the relevant pages and OPEN-QUESTIONS.md.
The 2026-10-12 sweep added two full-text-checked papers and a focused guideline entry. The 2026-10-19 sweep added four records (symptom-duration meta-analysis, Lancet Neurology review, Korean claims analysis, and the CSORN mild-DCM corrigendum) to the already-draft cervical-DCM page, bibliography, statistics sheet and open questions. The guideline page remains draft from 2026-10-12 and was not edited this sweep. The other 16 pages retain their 2026-08-30 curated status. All eight tracked NCT records were rechecked through ClinicalTrials.gov API v2 without a status or posted-results change; condition-search totals were 422 lumbar-spinal-stenosis and 58 degenerative-cervical-myelopathy records.
The 2026-10-26 sweep added two NICE documents to the guideline registry that had been missing since the build (NG59 recommendation 1.3.6 against epidurals for neurogenic claudication with central stenosis, and HTG238 on interspinous distraction) and summarized them on the already-draft guideline page. Two abstract-only cervical-surgery records sharpened OQ-11 and OQ-12. No other wiki page was edited; the tracked NCT records were unchanged.