Minimally Invasive Surgery for the Treatment of Lumbar Spinal Stenosis: A Comprehensive Review
TL;DR
The PILD procedure is a safe and effective MIS treatment for LSS specifically caused by ligamentum flavum hypertrophy in patients who have failed conservative care, offering reduced morbidity compared to open surgery, and its long-term efficacy relative to other MIS and traditional techniques requires further investigation.
Abstract
Lumbar spinal stenosis (LSS) is a prevalent and debilitating condition characterized by the narrowing of the spinal canal, leading to pain and neurogenic claudication. While open laminectomy is the gold standard for severe cases, it carries significant risks, especially for older patients. The variable success of non-surgical conservative treatments highlights the need for l minimally invasive interventions. This review compares available surgical options for LSS, with a focus on percutaneous image-Guided lumbar decompression (PILD) and minimally invasive spine (MIS) procedures. A literature review of clinical studies on MIS procedures for lumbar stenosis published between 2000 and 2025 was conducted via PubMed. The PILD procedure, which involves the percutaneous removal of hypertrophied ligamentum flavum, has demonstrated statistically significant reductions in pain and improvements in functional mobility in multiple studies, including three Level 1 randomized controlled trials. Pain relief emerges as early as six weeks and is sustained for up to two years, with a low rate of minor complications. Other MIS options include interspinous spacers and endoscopic decompression, which also show positive outcomes in select patient populations. The PILD procedure is a safe and effective MIS treatment for LSS specifically caused by ligamentum flavum hypertrophy in patients who have failed conservative care. While offering reduced morbidity compared to open surgery, its long-term efficacy relative to other MIS and traditional techniques requires further investigation.