Created: four seed files, 18 canonical pages, a draft overview with 25 PMIDs, and 7 seed questions.
Searches run (live PubMed E-utilities esearch/esummary): definition, prevalence and diagnostic accuracy; neurogenic claudication and cauda equina; nonoperative guideline, exercise and comparative care; epidural glucocorticoid trial; SPORT 4/8-year results; decompression versus fusion including Swedish and NORDSTEN trials; interspinous device; cervical myelopathy natural history/guideline; riluzole; digital gait markers.
Verification: every cited PMID was returned live by PubMed in this session.
Next: full build queued per CONDITIONS-ROADMAP.md; preserve the sibling boundary with degenerative disc disease.
Built: all 18 canonical wiki pages. The 17 missing pages were added and the seed overview was extended; every page is 169–189 lines, carries 25–34 full references, and remains status: draft pending the required separate-session audit.
Literature layer: created a 352-record master bibliography with cited-by mapping; six landmark notes (Jensen prevalence, Friedly epidural trial, SPORT four-year outcomes, Swedish fusion trial, NORDSTEN-DS, and the DCM guideline); a 17-document/module guideline registry with succession and disagreements; a >100-row statistics sheet; and four patient-voice files covering method/ethics, eight organizations, eight themes and annotated sources.
Open frontier: replaced the seven-question seed with 26 stable Tier 1/Tier 2 questions and a 14-row “Dots not yet connected” table.
Index/status: rebuilt INDEX.md with five-sentence portrait, reading paths, real page statuses and literature-layer counts; changed the condition row in CONDITIONS-ROADMAP.md from seeded to built.
Live PubMed searches (56 topic strategies; ESearch followed by EFetch): anatomy and quantitative MRI criteria; lumbar imaging and symptom discordance; prevalence and natural history; neurogenic claudication and objective walking; lumbar diagnosis and mimics; rehabilitation, exercise components and medications; epidural injection; percutaneous decompression and interspinous devices; lumbar decompression, complications and reoperation; degenerative spondylolisthesis and fusion trials; DCM reviews, natural history, diagnosis, imaging, gait, biomarkers, delay and falls; anterior/posterior cervical approaches, laminoplasty and fusion; frailty and postoperative delirium; outcomes/PROMs; qualitative lumbar/DCM research; cauda-equina syndrome; costs/quality of life; guidelines and society recommendations. The cache contains 463 live-fetched PubMed records; 352 are cited in the condition.
Additional guideline queries: live PubMed searches and summaries for the 2008 NASS predecessor (PMID 18082461), WFNS fusion/mobility modules (PMIDs: 32613190, 32613191), Italian Society of Neurosurgery consensus (PMID 32972117), and the Japanese 2021 guideline essence series (PMIDs: 37636139, 37636141, 37636148, 37636152, 37636153).
ClinicalTrials.gov: API v2 condition queries on 2026-08-29 returned 414 records for “Lumbar Spinal Stenosis” and 57 for “Degenerative Cervical Myelopathy.” The first 100 records per query produced 157 unique cached studies; every NCT ID written on the trials page was present in that response.
Patient-organization verification: direct HTTP fetches returned 200 for Myelopathy.org, National Spine Health Foundation, BackCare, World Spine Care, EUROSPINE Patient Line, Painaustralia, QuadPara Association of South Africa and Spinal Cord Injury Canada. Their scopes and the 2026-08-29 access date are recorded; adjacent SCI/pain organizations are explicitly not treated as stenosis-specific.
Build validation: every PMID appearing anywhere under conditions/spinal-stenosis/ was checked against the session's live E-utilities cache; every wiki inline PMID occurs in that page's ## References; every NCT resolves in the session's ClinicalTrials.gov response; all canonical page links and frontmatter were checked; no page was promoted to curated.
Could not verify / coverage limits: no condition-specific qualitative evidence from Africa, Latin America, the Middle East or South Asia was retrieved; caregiver burden, employment/financial toxicity and failed-device experience lack adequate stenosis-specific qualitative coverage. No completed DCM-specific ERAS guideline was retrieved (only a protocol, PMID 41206425). No validated biomarker, wearable treatment-selection rule, universal lumbar imaging threshold, or validated definition of instability requiring fusion was found; these are preserved as open questions rather than negative absolutes.
Next session: run the playbook's separate audit: re-fetch every identifier, compare each quantitative claim with the abstract/full text, remove any tangential evidence-map record, recheck current trial statuses, and promote only pages with zero unresolved substantive issue. Priority audit pages are injections/minimally invasive procedures, biomarkers/digital mobility and clinical-trials landscape because comparator nuance and rapidly changing records create the highest staleness risk.
Scope completed: ran the playbook's audit pass on all 18 wiki pages and every literature artifact: the 350-record bibliography, six landmark notes, 21-document guideline registry, statistics sheet, four patient-voice artifacts, and open-question register.
Live identifier verification: extracted the final corpus and re-fetched all 350 unique PMIDs through PubMed E-utilities on 2026-08-30; all 350 resolved. Compared 947 full reference and bibliography renderings with the live records for first author, publication year and full title; zero metadata mismatches remain. Re-fetched all eight cited NCT records individually through ClinicalTrials.gov API v2 and refreshed the two condition queries; all eight resolved, while the condition snapshots remained 414 lumbar-spinal-stenosis records and 57 degenerative-cervical-myelopathy records.
Claim-to-citation corrections: replaced 51 generic, mechanically paired open-question/source combinations across 17 pages with page-specific questions and directly relevant evidence. Rechecked the principal prevalence, natural-history, diagnostic, rehabilitation, injection, surgical, frailty, walking and DCM numerical anchors against live abstracts. Corrected four Minetama responder-difference rows from “points” to “percentage points”; no other audited anchor required a numerical change.
Stale absence searches: reran targeted live searches for biomarker validation, wearable treatment selection, lumbar MRI thresholds, fusion-effect modifiers, DCM surveillance intervals, DCM-specific ERAS guidance, caregiver experience, employment effects, regional qualitative evidence and failed-device experience. Replaced the stale categorical biomarker absence with the current distinction between external validation and demonstrated clinical impact, adding an externally validated smartphone-screening study and an internally validated MRS prognostic model. Added the retrieved postoperative employment cohort and converted the remaining genuine gaps into dated, positive evidence-gap statements.
Guidance and perioperative coverage: added four omitted/current guidance records (WFNS conservative/percutaneous recommendations, MIST 2.0, standardized pathway Delphi consensus and ISSLS outcome-measure consensus), plus live-supported bone-health and prehabilitation syntheses. The guideline registry increased from 17 to 21 documents/modules.
Relevance and evidence-map cleanup: added 11 newly verified PMIDs and removed 13 off-scope or newly uncited master records, leaving 350 unique records. Removed 11 tangential rows from the patient-experience evidence map, removed clearly off-scope biomarker and guideline records, and corrected systematic evidence-map design labels against live PubMed publication types and titles. Rebuilt all bibliography cited by mappings and synchronized every page's full references to the live-verified master metadata.
Patient voice and external sources: rechecked the qualitative source ledger, added evidence on employment and treatment decisions, and live-fetched all eight organization URLs with successful HTTP responses. Coverage limitations are stated without treating adjacent pain or spinal-cord-injury organizations as stenosis-specific evidence.
Final consistency checks: every inline/evidence-map PMID on each page appears in that page's ## References, and no page has an extra full reference; all canonical internal page links resolve; each page retains the required sections, 150–400 lines and 25–60 references. No [unverified] flag or unresolved substantive citation issue remains.
Residual evidence gaps, not audit failures: dated searches still found no stenosis-specific caregiver qualitative study, no adequate qualitative evidence centered on regional inequity or failed-device/reoperation experience, no completed DCM-specific ERAS guideline beyond a protocol, no validated surveillance interval for mild DCM, and no externally validated clinical-impact rule selecting fusion or wearable-guided treatment. These are explicitly preserved as current evidence gaps rather than claims of timeless nonexistence.
Status: promoted all 18 pages to status: curated and changed the spinal-stenosis roadmap state from built to audited.
Searches: PubMed E-utilities ESearch with publication dates 2026-08-28 through 2026-10-12 for 12 major topics (anatomy/imaging, epidemiology/natural history, lumbar diagnosis/walking, rehabilitation, injections/devices, decompression, fusion/spondylolisthesis, cervical DCM, frailty/safety, biomarkers/outcomes, guidelines and patient experience), plus a separate Cochrane Database of Systematic Reviews journal-filtered PubMed search for each topic. All 12 Cochrane queries returned zero records in PubMed in that window; two HTTP 429 responses were retried successfully. Europe PMC REST was queried for the same 12 topics with FIRST_PDATE:[2026-08-28 TO 2026-10-12]; its non-PMID records were screened but none warranted a DOI citation. Exact query strings, PubMed translations, returned IDs and source checks are in the sweep manifest.
Registry and external checks: All eight NCT IDs already cited by this condition were retrieved individually through ClinicalTrials.gov API v2; no overall-status or posted-results change was found relative to the August audit. Checked the NASS guideline catalogue, EUROSPINE Spine Atlas DCM data call/results pages, National Spine Health Foundation material, and site-scoped Myelopathy.org results. The 2026 NASS intervention-training position statement is not a replacement lumbar-stenosis clinical guideline; the new National Spine Health Foundation episode is general spine education, so neither was added. No new condition-specific burden figure survived triage. The WHO ICTRP portal loaded but did not yield searchable results programmatically; ISRCTN search redirected to a holding page, and ChiCTR was checked through its search interface and indexed site results. Cochrane CENTRAL and Library full text were not searched; the CDSR check used PubMed. SciELO search returned HTTP 403 and the LILACS/BVS query timed out, so this sweep cannot support a global absence claim about regional research or trials.
Survived triage: Full-text review identified the focused 2026 AO Spine recommendations for mild DCM and a prospective multicentre cohort showing discordance between clinician- and patient-reported mild classifications (Neal 2026, PMID 42784504; Kitagawa 2026, PMID 42670800). Both PMIDs came from this session's live PubMed E-utilities queries; neither PubMed publication types nor Crossref updated-by flagged retraction or concern. The cohort's cross-classification figures were checked against full-text Table 1. No paper warranted a landmark deep note.
Changed: Added two bibliography records; updated the cervical-DCM and guideline wiki pages, guideline registry, two DCM statistics rows, OQ-9 and the regional-literature limit under OQ-25; synchronized INDEX counts and statuses. The two edited wiki pages are draft pending independent audit. The other 16 wiki pages were untouched.
Next: Independently audit the two edited pages and their new references; recheck whether AO Spine publishes a full guideline revision, whether EUROSPINE releases analyzable DCM Atlas results, and whether any tracked trial posts results or changes status. Retrieve the full text of the dynamic sagittal tether IDE report and the lumbar surgery education study before considering either for a wiki claim. Retry WHO ICTRP/ISRCTN/ChiCTR and SciELO/LILACS access for broader geographic trial and patient-experience coverage.
Searches: PubMed E-utilities ESearch/ESummary/EFetch with publication dates 2026-08-28 through 2026-10-19 for the same 12 major topics as 2026-10-12 (anatomy/imaging, epidemiology/natural history, lumbar diagnosis/walking, rehabilitation, injections/devices, decompression, fusion/spondylolisthesis, cervical DCM, frailty/safety, biomarkers/outcomes, guidelines, patient experience), plus a "Cochrane Database Syst Rev"[jour] PubMed search for each topic. Three HTTP 429 responses were retried successfully. All 12 Cochrane queries returned zero records in PubMed in this window. Europe PMC REST was queried for the same 12 topics with FIRST_PDATE:[2026-08-28 TO 2026-10-19]; non-PMID records (PMC-only items and preprints) were screened and none warranted a DOI citation. Exact query strings, translations, returned IDs and source checks are in the sweep manifest.
Registry and external checks: All eight NCT IDs already cited by this condition were retrieved individually through ClinicalTrials.gov API v2; overall status and posted-results flags were unchanged relative to the 2026-10-12 sweep (NCT07588555 recruiting; NCT06079580 completed; NCT06525896 active, not recruiting; NCT06381167 not yet recruiting; NCT03801356 terminated with results; NCT02079038 completed with results; NCT01987622 completed; NCT07001969 enrolling by invitation). Condition searches returned 422 records for “Lumbar Spinal Stenosis” and 58 for “Degenerative Cervical Myelopathy” (414 and 57 on 2026-08-30). NASS guideline archives and the existing lumbar-stenosis PDF were fetched; no replacement lumbar-stenosis clinical guideline was present. AO Spine RECODE-DCM page loaded; no full DCM guideline revision was found. EUROSPINE Spine Tango / DCM Atlas URLs returned 404; the research homepage loaded without analyzable Atlas results. Myelopathy.org news listed a perioperative-care survey headline; the article URL was not resolved (guessed slugs 404) and was not added. All eight previously verified patient-organization homepages returned HTTP 200. EudraCT HTML search for "spinal stenosis" returned 12 historical protocols (2004–2019), none new in this window. WHO ICTRP portal loaded but is JS-driven and not programmatically searchable. ISRCTN search redirected to a holding page. ChiCTR search returned HTTP 200 without extractable result rows. CTRI timed out. Cochrane CENTRAL and Library full text were not searched (cochranelibrary.com HTTP 403); the CDSR check used PubMed. SciELO search returned HTTP 403 and LILACS/BVS timed out, so this sweep cannot support a global absence claim about regional research or trials. Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL was not set.
Survived triage: (1) Szymoniuk 2026, PMID 42891726 — 14-study / 3,162-patient SRMA of symptom duration versus postoperative mJOA; numbers taken from the live-fetched PDF (univariate OR 2.15, multivariate OR 1.78; 6- and 12-month cut-offs significant; subgroup-difference p = 0.89; no recommendable threshold). (2) Zipser 2026, PMID 42869062 — Lancet Neurology review restating severity-linked surgery and reactive current care; Lancet full text HTTP 403, so only abstract-supported claims were used. (3) An 2026, PMID 42889131 — Korean HIRA claims 2010–2024; Table 2/4 numbers from PMC full text; authors interpret the falling DCM diagnosis rate as coding change, so it was not entered as a burden decline. (4) Kögl 2026 corrigendum, PMID 42875892 — Ovid full text of the erratum to the already-cited CSORN mild-DCM nonoperative cohort (PMID 41090907); revises crossover subset counts only. PubMed publication types and Crossref updated-by were empty of retraction/concern for all four; the Kögl record is a corrigendum, not a retraction. No paper warranted a landmark deep note. No new society guideline replaced NASS 2013 or AO Spine 2017.
Did not survive: 25 PMIDs were new versus the 2026-10-12 sweep. Case reports, letters, comments, endoscopic technique series, bibliometrics, a nursing-framework review, and a facet-morphology SRMA (association, not a fusion treatment-effect modifier) were dropped. The dynamic sagittal tether IDE report (PMID 42672109; NCT03115983) still lacks a usable full text (Ovid login wall) and remains deferred. The YouTube/TikTok/Bilibili education study (PMID 42798124) and CSORN mixed-lumbar wait-time paper (PMID 42810738) were not stenosis-specific enough for a wiki claim. An ATTR-amyloid LSS review (PMID 42864788) was not added without verifying its “approximately half” flavum estimate against primary tables.
Changed: Four bibliography records (356 unique PMIDs). Cervical-stenosis-and-myelopathy wiki page updated (already draft). STATISTICS.md gained Kögl, Szymoniuk and An rows plus three caveats. OQ-9 and OQ-11 sharpened; OQ-25 notes the Korean coding finding and restates the SciELO/LILACS limit. Guideline registry, patient-voice files, and the other 16 wiki pages were untouched. INDEX counts synchronized.
Next: Independently audit the draft cervical-DCM and guideline pages and the four new 2026-10-19 references. Recheck AO Spine for a full guideline revision and EUROSPINE for analyzable DCM Atlas results. Retrieve full text of the DST IDE trial (PMID 42672109) before any wiki claim; it is a propensity-score IDE versus TLIF, not versus decompression alone. Resolve the Myelopathy.org perioperative-care survey URL if it is still listed. Recheck the eight tracked NCT IDs, especially NCT06525896 (primary completion 2026-08-31). Retry WHO ICTRP/ISRCTN/ChiCTR and SciELO/LILACS. Watch for a published (non-preprint) chiropractic older-adult musculoskeletal guideline (Europe PMC PPR1327800) and the smartphone-gait CSM preprint (PPR1325500).
Searches: PubMed E-utilities ESearch/ESummary/EFetch with publication dates 2026-08-28 through 2026-10-26 for the same 12 topics as the two previous sweeps, plus an entrez-date supplement (2026-10-19 to 2026-10-26 [edat]) per topic to catch records indexed since last week whatever their publication date. Ran the "Cochrane Database Syst Rev"[jour] PubMed filter for each topic: all 12 returned zero. A broader CDSR query (stenosis/myelopathy/spondylolisthesis/neurogenic claudication/laminectomy) returned one record, a spinal-cord-injury exercise review (PMID 42663176), which is off scope. No new or updated Cochrane review for this condition is in PubMed in this window. Europe PMC REST was queried for the 12 topics with FIRST_PDATE:[2026-08-28 TO 2026-10-26]; 96 records not seen in earlier manifests were screened, mostly free-text noise (disc herniation, amyloid cardiomyopathy, isthmic spondylolisthesis), and none warranted citation. Against the 2026-10-12 and 2026-10-19 manifests, 16 PubMed records were new. Exact queries, translations, IDs and checks are in the sweep manifest.
Registry and external checks: Fetched all eight tracked NCT IDs individually through ClinicalTrials.gov API v2. None changed status, results flag, dates or last-update date. NCT06525896 is still ACTIVE_NOT_RECRUITING with a primary completion date of 2026-08-31 that has passed and has not been updated. Condition counts were 423 for lumbar spinal stenosis (422 last week) and 58 for DCM. The only record first posted since 2026-10-19 was an acute spinal-cord-injury stimulation trial, which is off scope. NASS still lists the same three lumbar guidelines. The AO Spine RECODE-DCM URL now returns 404. Myelopathy.org shows no new item that could be resolved and added. The EU CTR returned an empty 244-byte response, ISRCTN a holding page, and WHO ICTRP is driven by JavaScript and could not be searched programmatically. ChiCTR, CTRI and LILACS were not retried. Cochrane CENTRAL was not searched (cochranelibrary.com HTTP 403). SciELO returned HTTP 403, so nothing here supports an absence claim about regional literature or trials. Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL is unset. Crossref calls sent no mailto.
Most important finding — guideline-registry omission: A NICE site search showed that two NICE documents have been missing from the registry since the build. (1) NG59 (2016; last updated 2026-07-29), recommendation 1.3.6, quoted verbatim from the live page: "Do not use epidural injections for neurogenic claudication in people who have central spinal canal stenosis. [2016]". Recommendation 1.3.5 allows epidurals to be considered for acute and severe sciatica. The July 2026 update withdrew only the psychological-therapy recommendations. (2) HTG238, formerly IPG365 (2010; renumbered January 2026 with the text unchanged), permits interspinous distraction for carefully selected patients, with governance and specialist selection. Its text predates the five-year spacer reoperation data. These are not new publications. They are a gap in this sweep lineage's coverage, which until now had relied on PubMed and did not search the NICE site. The PubMed-only method is how they were missed.
Survived triage (literature): Akai 2026, PMID 42922089 (laminoplasty cohort: 123/163 had patient-reported bladder dysfunction before surgery; 27/123 improved at two years) and Howell 2026, PMID 42913512 (QOD CSM, n = 904: 44.7% reached substantial clinical benefit on the NDI; predictors were baseline neck pain, anterior approach and fusion not stopping at C7). Both are abstract-only. The Ovid page served only the abstract and LWW/JNS full text was not retrievable, so the numbers were used only in OPEN-QUESTIONS, labelled as abstract-sourced, and not in a wiki page or STATISTICS.md. Neither the PubMed publication types nor Crossref updated-by flag a retraction or concern for either record or for the two deferred Spine J records.
Did not survive: Kelleher 2026 (PMID 42896811; NSQIP failure-to-rescue after DCM surgery, a generic quality metric, abstract only). Kumanomido 2026 (PMID 42901460; residual low back pain after single-level decompression; Crossref shows a CC BY-NC-ND licence but ScienceDirect returned 403). This is a candidate for lumbar-decompression once the full text is read. The AO Spine lumbosacral interbody recommendations (PMID 42925017) cover technique and alignment and isthmic spondylolisthesis, not stenosis, so they were not entered in the registry. Case reports, an editorial, imaging-sequence and fMRI studies, an epidural-lipomatosis lipid association study and a small cross-sectional psychology study were dropped. No landmark note.
Changed: REGISTRY.md gained rows #23–24, a NICE section, two updated disagreement rows and a supersession line (24 documents). wiki/guidelines.md gained a NICE section, two decision-table rows and two URL references. It was already draft, stays draft, and last-curated is now 2026-10-26. OQ-11 is sharpened on sphincter recovery and timing, OQ-12 on baseline axial pain and approach. BIBLIOGRAPHY.md has 358 records. INDEX counts are synchronized. The other 17 wiki pages, STATISTICS.md and the patient-voice files are untouched.
Next: Independently audit the draft guideline page (the 2026-10-12 and 2026-10-26 edits) and the draft cervical-DCM page. Consider whether the curated injections page should cross-reference NICE NG59 1.3.6 and HTG238; an auditor should decide, because editing it would demote it. Get the Kumanomido full text for lumbar-decompression and the Akai full text before any wiki or statistics use. Watch NCT06525896 for a status update now that primary completion has passed. Search other national guideline portals with the same non-PubMed method (e.g. German AWMF, Scandinavian national guidance, Australian/Canadian bodies) for further omissions of the NICE kind. Retry ChiCTR/CTRI/ICTRP and SciELO/LILACS. Carry forward the DST IDE full text (PMID 42672109) and the published version of preprints PPR1327800/PPR1325500.