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Clinical Outcomes in Lumbar Spinal Stenosis Treatment
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Clinical Outcomes in Lumbar Spinal Stenosis Treatment

A Special Issue of Journal of Clinical Medicine (ISSN 2077-0383) belonging to the section "Orthopedics".

Deadline for manuscript submissions: 20 March 2027 | Viewed by 1647

Editors

Dr. Rafał Staszkiewicz

E-Mail Website
Guest Editor
1. Collegium Medicum, WSB University, 41-300 Dabrowa Gornicza, Poland
2. Department of Neurosurgery, 5th Military Clinical Hospital with the SP ZOZ Polyclinic in Krakow, 30-901 Krakow, Poland
3. Department of Neurosurgery, Faculty of Medicine in Zabrze, Academy of Silesia, 40-555 Katowice, Poland
Interests: lumbar spinal stenosis; clinical outcomes; decompression surgery; inflammation and fibrosis
Prof. Dr. Beniamin Oskar Grabarek

E-Mail Website
Guest Editor
Collegium Medicum, WSB University, 41-300 Dabrowa Gornicza, Poland
Interests: gene expression; epigenetics; drug resistance; cancer; tumor microenvironmental
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Lumbar spinal stenosis (LSS) is a prevalent degenerative condition and a major source of pain, disability, and reduced quality of life in the aging population. Despite advances in diagnostic imaging and surgical techniques, optimal treatment selection and prediction of clinical outcomes remain challenging. This Special Issue invites original research, reviews, and meta-analyses addressing the full spectrum of LSS management—from conservative and pharmacological therapies to minimally invasive and open surgical approaches. We particularly encourage submissions that integrate molecular and cellular perspectives, including studies exploring inflammatory mediators, growth factors, neurotrophins, fibrosis-related pathways, and extracellular matrix remodeling in ligamentum flavum or intervertebral disk degeneration. Clinical research linking biomarkers, genetic or epigenetic factors, and molecular signaling pathways (e.g., TGF-β, MAPK, PI3K/AKT) with clinical or imaging outcomes is especially welcome. Additional topics of interest include rehabilitation strategies, long-term functional recovery, pain modulation, and quality-of-life assessment. Through a multidisciplinary lens bridging clinical and molecular sciences, this Special Issue aims to advance personalized approaches in lumbar spinal stenosis treatment.

Dr. Rafał Staszkiewicz
Prof. Dr.  Beniamin Oskar Grabarek
Guest Editors

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Keywords

  • lumbar spinal stenosis
  • clinical outcomes
  • decompression surgery
  • conservative management
  • molecular biomarkers
  • inflammation and fibrosis
  • neurotrophic factors
  • personalized medicine
  • siganling pathways
  • quality of life

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Published Papers (2 papers)

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Research

13 pages, 959 KB  
Article
Transforaminal Endoscopic Lumbar Foraminotomy for Radiculopathy at the Fused Segment After Lumbar Fusion: Clinical Outcomes and Surgical Considerations
by Yong Ahn, Han-Byeol Park, Sung-Ho Do and Sojung Lee
J. Clin. Med. 2026, 15(12), 4789; https://doi.org/10.3390/jcm15124789 - 20 Jun 2026
Cited by 1 | Viewed by 621
Abstract
Background: Radiculopathy originating from a previously fused lumbar segment is a clinically relevant but often underrecognized problem. Progressive foraminal stenosis may develop due to postoperative structural changes, leading to mechanical irritation of the exiting nerve root. Transforaminal endoscopic lumbar foraminotomy (TELF) is a [...] Read more.
Background: Radiculopathy originating from a previously fused lumbar segment is a clinically relevant but often underrecognized problem. Progressive foraminal stenosis may develop due to postoperative structural changes, leading to mechanical irritation of the exiting nerve root. Transforaminal endoscopic lumbar foraminotomy (TELF) is a minimally invasive option, but its role in this setting is not well defined. Methods: In this retrospective cohort study, we included 36 consecutive patients who underwent TELF for symptomatic foraminal stenosis at a previously fused segment between 2020 and 2023. Clinical outcomes were assessed using the visual analog scale (VAS) for leg pain, Oswestry Disability Index (ODI), and modified MacNab criteria, with follow-up of up to 2 years. Radiographic and intraoperative findings were reviewed to explore the underlying mechanisms. Results: The mean VAS score improved significantly from 8.36 preoperatively to 2.00 at 2 years, and the mean ODI decreased from 70.9% to 16.8%. According to the modified MacNab criteria, 86.1% of the patients achieved excellent or good outcomes. Intraoperative findings revealed fibrotic or hypertrophic foraminal stenosis in 86.1% patients (n = 31), whereas 13.9% of patients (n = 5) showed pedicle screw-related nerve root irritation. Five patients experienced transient postoperative dysesthesia, and no postoperative instability was observed. Conclusions: Radiculopathy at the fused segment is primarily caused by progressive mechanical foraminal compromise after fusion. TELF provides effective symptom relief through direct decompression and may serve as a less invasive alternative to revision fusion in selected patients. Full article
(This article belongs to the Special Issue Clinical Outcomes in Lumbar Spinal Stenosis Treatment)
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11 pages, 2418 KB  
Article
Neurological Phenotype and MRI Severity as Predictors of Duloxetine Response in Lumbar Spinal Stenosis: A Retrospective Cohort Study
by Kazuya Honjoh, Arisa Kubota, Shuji Watanabe, Mikiko Kamitani, Yumiko Watanabe and Hideaki Nakajima
J. Clin. Med. 2026, 15(10), 3708; https://doi.org/10.3390/jcm15103708 - 12 May 2026
Cited by 1 | Viewed by 637
Abstract
Background/Objectives: Lumbar spinal canal stenosis (LSS) is a major cause of neurological disability and is frequently accompanied by neuropathic pain (NeP). Duloxetine is widely used for NeP, but its clinical role in LSS and the determinants of treatment response remain unclear. This study [...] Read more.
Background/Objectives: Lumbar spinal canal stenosis (LSS) is a major cause of neurological disability and is frequently accompanied by neuropathic pain (NeP). Duloxetine is widely used for NeP, but its clinical role in LSS and the determinants of treatment response remain unclear. This study aimed to identify predictors of duloxetine efficacy in LSS. Methods: We retrospectively analyzed 145 patients with LSS who received duloxetine for ≥3 months (median dose 40 mg) with at least 1-year follow-up. Patients were classified into those with radicular pain or cauda equina syndrome. Treatment response was assessed at 3 months. Stenosis severity was evaluated using the Schizas classification. Multivariable logistic regression analysis was performed to identify independent predictors of duloxetine response in patients with cauda equina syndrome. Results: Duloxetine was effective in 29.4% vs. 52.3% in radicular pain and cauda equina syndrome, respectively. Among patients with cauda equina syndrome, Schizas Grade D was more frequent in responders than non-responders and independently predicted duloxetine response. Nearly 90% of responders had been unresponsive to other NeP medications. A subset of patients with severe stenosis avoided surgery following duloxetine treatment. Conclusions: Duloxetine showed greater efficacy in cauda equina-dominant LSS compared with radicular pain. Paradoxically, more severe spinal canal stenosis tended to be associated with a higher likelihood of response. These findings suggest that neurological phenotype and radiological severity may influence duloxetine responsiveness and support a symptom- and imaging-guided pharmacological management for LSS, although these findings should be interpreted with caution and considered hypothesis-generating given the retrospective study design. Full article
(This article belongs to the Special Issue Clinical Outcomes in Lumbar Spinal Stenosis Treatment)
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