Clinical practice guidelines registry — spinal stenosis¶
Last curated: 2026-08-30
Method. PubMed E-utilities was queried live for lumbar-spinal-stenosis and degenerative-cervical-myelopathy guidelines, society recommendations and historical predecessors. Current in retrieved lineage means the newest document found for that issuing lineage and scope on 2026-08-30; it is not a claim that no unindexed local document exists. Recommendations are synthesized in guidelines.md; this file catalogs documents and succession.
Master table¶
| # | Body / document | Year | Region | Scope | Citation | Status |
|---|---|---|---|---|---|---|
| 1 | North American Spine Society (NASS) original evidence-based guideline | 2008 | North America | Degenerative lumbar stenosis: diagnosis and treatment | Watters et al. PMID 18082461 | superseded by → #2 |
| 2 | NASS updated evidence-based guideline | 2013 | North America | Degenerative lumbar stenosis: diagnosis and treatment | Kreiner et al. PMID 23830297 | current in retrieved NASS lineage; aging |
| 3 | Multidisciplinary guideline (chiropractic, primary care, rehabilitation and specialist panel) | 2021 | International/North America | Nonsurgical care for LSS causing neurogenic claudication | Bussières et al. PMID 33857615 | current in retrieved nonsurgical lineage |
| 4 | WFNS Spine Committee — natural course and diagnosis | 2020 | International | Definition, diagnosis, natural history | Zileli et al. PMID 32613187 | current WFNS module |
| 5 | WFNS Spine Committee — decompression | 2020 | International | Decompressive surgery | Costa et al. PMID 32613189 | current WFNS module |
| 6 | WFNS Spine Committee — fusion | 2020 | International | Fusion indications | Sharif et al. PMID 32613190 | current WFNS module |
| 7 | WFNS Spine Committee — mobility preservation | 2020 | International | Interspinous and motion-preserving surgery | Roitberg et al. PMID 32613191 | current WFNS module |
| 8 | Italian Society of Neurosurgery, Spinal Section | 2021 | Italy | Consensus on degenerative lumbar stenosis | Costa et al. PMID 32972117 | current in retrieved Italian lineage |
| 9 | Japanese Orthopaedic Association guideline essence: definition/natural history | 2021; English series 2023 | Japan | Definition, epidemiology, natural history | Sekiguchi et al. PMID 37636141 | current module |
| 10 | Japanese guideline essence: diagnosis/evaluation | 2021; English series 2023 | Japan | Diagnostic and evaluation recommendations | PMID 37636148 | current module |
| 11 | Japanese guideline essence: conservative treatment | 2021; English series 2023 | Japan | Conservative treatments | PMID 37636152 | current module |
| 12 | Japanese guideline essence: surgical treatment | 2021; English series 2023 | Japan | Surgical treatments | PMID 37636139 | current module |
| 13 | Japanese guideline essence: postoperative prognosis | 2021; English series 2023 | Japan | Prognosis after surgery | PMID 37636153 | current module |
| 14 | AO Spine/CSRS DCM clinical practice guideline | 2017 | International | Mild/moderate/severe DCM and nonmyelopathic compression | Fehlings et al. PMID 29164035 | current core DCM guideline |
| 15 | AO Spine DCM evidence-based recommendations review | 2025 | International | New evidence and practice recommendations | Fehlings et al. PMID 40257837 | current update/review; supplements #14 |
| 16 | American College of Radiology Appropriateness Criteria — low back pain | 2021 | United States | Imaging triage, including severe/progressive neurology | Hutchins et al. PMID 34794594 | current in retrieved ACR lineage |
| 17 | American Academy of Neurology guideline-subcommittee review | 2025 | United States | Epidural steroids for radicular pain and spinal stenosis | Armon et al. PMID 39938000 | current evidence review |
| 18 | WFNS Spine Committee — conservative treatment and percutaneous pain relief | 2020 | International | Exercise/physical care, medication and percutaneous techniques | Fornari et al. PMID 32613192 | current WFNS module |
| 19 | American Society of Pain and Neuroscience MIST 2.0 | 2022 | United States | Minimally invasive lumbar-stenosis treatment | Deer et al. PMID 35546905 | current retrieved MIST lineage |
| 20 | International lumbar-stenosis treatment-pathway Delphi | 2022 | International | Standardized stepped treatment algorithm | Comer et al. PMID 35676677 | current retrieved pathway consensus |
| 21 | ISSLS lumbar-stenosis taskforce | 2025 | International | Consensus clinical outcome measures | Anderson et al. PMID 40924201 | current retrieved outcomes consensus |
Per-guideline notes¶
NASS lumbar lineage (#1 → #2)¶
The 2008 guideline was the first NASS evidence-based document retrieved in this session (PMID 18082461). The 2013 update explicitly succeeds it and remains the newest PubMed-indexed NASS lumbar-stenosis guideline found (PMID 23830297). It predates the major 2016–2024 decompression-versus-fusion trials, so its fusion sections require reading beside newer randomized evidence.
Nonsurgical neurogenic-claudication guideline (#3)¶
This guideline addresses the clinical syndrome rather than imaging-only narrowing. It supports multimodal nonpharmacological care and recommends against epidural steroid injection for lumbar stenosis causing neurogenic claudication (Bussières 2021, PMID 33857615). Its explicit syndrome boundary is a strength; certainty for individual exercise components remains limited.
WFNS modular recommendations (#4–7 and #18)¶
WFNS separated natural history/diagnosis, conservative and percutaneous care, decompression, fusion and mobility-preserving procedures into distinct documents (PMIDs: 32613187, 32613192, 32613189, 32613190, 32613191). This modularity makes disagreements traceable: agreement that decompression is appropriate for selected persistent symptomatic disease does not imply agreement that fusion or a device is necessary.
Procedure, pathway and outcomes consensus (#19–21)¶
The 2022 ASPN MIST 2.0 document addresses minimally invasive lumbar-stenosis interventions (Deer 2022, PMID 35546905), while an international Delphi panel proposed a standardized stepped treatment pathway (Comer 2022, PMID 35676677). The 2025 ISSLS taskforce addresses clinical outcome measures rather than treatment efficacy (Anderson 2025, PMID 40924201); it is cataloged separately so measurement consensus is not mistaken for a therapeutic recommendation.
Italian consensus (#8)¶
The Italian Society of Neurosurgery spinal-section consensus covers degenerative lumbar stenosis across diagnosis and management (Costa 2021, PMID 32972117). It is retained separately from WFNS because issuing body and consensus process differ even where authors overlap.
Japanese 2021 guideline essence (#9–13)¶
The English 2023 series exposes five modules from the 2021 Japanese guideline: definition/natural history, diagnosis, conservative care, surgery and prognosis (PMIDs: 37636141, 37636148, 37636152, 37636139, 37636153). The modular set is the broadest current national lineage retrieved outside North America.
AO Spine/CSRS DCM guideline and update (#14–15)¶
The 2017 guideline organizes DCM by clinical severity and trajectory: surgery for moderate/severe disease; surgery or supervised structured rehabilitation for mild disease; surgery for deterioration; and observation/education rather than prophylactic surgery for nonmyelopathic compression without radiculopathy (Fehlings 2017, PMID 29164035). The 2025 AO Spine review integrates newer literature but supplements rather than formally supersedes the full guideline (Fehlings 2025, PMID 40257837).
Imaging and injection guidance (#16–17)¶
ACR appropriateness criteria support imaging escalation for severe/progressive neurological features rather than routine imaging of uncomplicated low-back pain (Hutchins 2021, PMID 34794594). The AAN review distinguishes radicular pain from spinal stenosis when grading epidural-steroid evidence (Armon 2025, PMID 39938000); those populations should not be collapsed.
Disagreements and gaps¶
| Junction | Position A | Position B / unresolved issue | Why it matters |
|---|---|---|---|
| Epidural steroid | 2021 nonsurgical guideline recommends against use for neurogenic claudication | Injection remains common; AAN estimates vary by condition and horizon | Within-group response is often mistaken for added steroid effect |
| Fusion | Older guidance permits fusion around spondylolisthesis/instability | Recent randomized trials show decompression alone is sufficient for many | “Instability” lacks a validated treatment-effect definition |
| Conservative package | Multimodal education/exercise/manual care supported | Optimal exercise component, dose and supervision unresolved | Programs are difficult to reproduce |
| Mild DCM | Surgery or structured rehabilitation both permissible | Individual deterioration risk is poorly predicted | Monitoring intensity is not standardized |
| Imaging thresholds | Quantitative and qualitative grades catalog anatomy | No threshold independently diagnoses symptoms or predicts treatment effect | Avoids scan-driven treatment |
| Devices | Mobility-preservation modules discuss selective use | Reoperation and comparator choice remain contentious | Shorter index procedure may redistribute later burden |
| Older adults | Age alone is not an exclusion | Frailty, cognition, bone and discharge planning are inconsistently operationalized | Net benefit differs from technical success |
Supersession map¶
- NASS 2008 (PMID 18082461) → NASS update 2013 (PMID 23830297).
- Japanese 2021 guideline modules are represented by the 2023 English “Essence” series (PMIDs: 37636141, 37636148, 37636152, 37636139, 37636153); no earlier Japanese lineage was verified in this session.
- AO Spine/CSRS 2017 (PMID 29164035) → supplemented, not formally replaced, by AO Spine 2025 evidence review (PMID 40257837).
- WFNS 2020 documents are parallel modules, not a supersession chain.
Watch list¶
- Formal NASS replacement for the 2013 lumbar-stenosis guideline.
- A full AO Spine DCM guideline revision that explicitly supersedes 2017.
- National guidance that incorporates five-year NORDSTEN-DS and Swedish trial follow-up.
- ERAS recommendations specific to DCM surgery; a 2026-08-30 update search still retrieved only the development protocol (Treanor 2025, PMID 41206425), not completed guidance.
- Guidelines defining how wearables or objective walking should influence decisions.
- Guidance for frailty, osteoporosis and delirium specifically in stenosis surgery rather than spine surgery generally.