A narrative review and scoring proposal for secondary lumbar instability after lumbar decompression surgery

PMCID: PMC12177027

PMID: 40531241

DOI: 10.1007/s00701-025-06590-9

Journal: Acta neurochirurgica

Publication Date: 2025-6-18

Authors: Abramovic A, Lener S, Hartmann S, Thomé C

Key Points

• A comprehensive 14-point scoring system was developed to predict secondary lumbar instability risk after decompressive surgery
• Key risk factors include disc height > 6.5 mm (2 points), mechanical low back pain (2 points), and patient characteristics like age, BMI, and gender
• The score offers a preliminary theoretical framework for identifying patients who may require more cautious surgical planning or consideration of fusion techniques

Summary

This comprehensive literature review addresses the critical challenge of predicting secondary lumbar instability (SLI) following decompressive surgery (DS) for lumbar spinal stenosis. By systematically analyzing 25 studies encompassing 9,754 patients, the researchers developed a novel 14-point risk assessment score to identify patients at higher risk of developing post-surgical spinal instability.

The study identified multiple clinical and radiological predictors of SLI, including preoperative instability, disc height > 6.5 mm, surgical invasiveness, and patient-specific factors such as BMI, age, gender, and mechanical low back pain. The resulting risk stratification tool provides clinicians with a structured approach to preoperatively assess the likelihood of developing SLI, potentially guiding more personalized surgical decision-making and patient counseling.