Aref safari, - -Department of Cellular and Molecular Biology, Faculty of Advanced Sciences and technology, Tehran MedicalSciences Branch, Islamic Azad University, Tehran, Iran
Issa Layali - Departmaent of Biochemistry and Biophysics, Tehran Medical Sciences Branch, Islamic Azad University,Tehran, Iran

Lumbar spinal stenosis (LSS) affects more than ۲۰۰ ۰۰۰ adults in the United States, resulting in substantial painand disability. It is the most common reason for spinal surgery in patients over ۶۵ years. Lumbar spinal stenosis isa clinical syndrome of pain in the buttocks or lower extremities, with or without back pain.Clinical care andresearch into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standardcriteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in olderpeople who are completely asymptomatic.Several different surgical procedures are used to treat patients who donot improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax andwane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersomesymptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better.for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited qualityMethodologyWe explored databases of PubMed and Google Scholar and identified articles that were published between۱۹۹۰and ۲۰۲۳ with these keywords: "Lumbar spinal stenosis" "LSS" "Surgery in LSS" "vertebral columns" and."Anatomy of vertebral columns" Then we chose about ۸۰ articles and we deleted some of them by our scopeResultsThere is limited information from high quality studies about the relative benefits and harms of commonly usedtreatments. Interpreting and comparing results of available research is limited by a lack of consensus about thedefinition of LSS. Nevertheless, evidence supports decompressive laminectomy for patients with persistent andbothersome symptoms. Recommendations favor a shared decision making approach due to important trade-offs.between alternative therapies and differences among patients in their preferences and valuesDiscussion and Conclusionthere has been a longstanding need forevidencebaseddata on which to base treatment decisions for LSS, and this need has become increasinglyimportant as the frequency of diagnosis has increased.The first randomized, prospective studies have provided class ۱b evidence that in the short term, decompressivesurgery produces a faster and more profound decline of symptoms than conservative therapy. However, in view ofthe narrowing of this effect during followupand in the absence of a valid paraclinical technical (surrogate)marker, more midtermand longtermevidencebaseddata are needed to identify patients for whom the benefitsof surgery would outweigh the risk of developing complications. Likewise, future studies should compare theeffectiveness of the various nonsurgical, conservative treatments for LSS, as there is little supporting evidence forthe current methods.

vertebral columns,vertebrae,Lumbar Spinal stenosis(LSS),Surgery,Symptom