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.