Lumbar approaches and procedures for spinal stenosis (Neurocore-LAPS): an international survey of decompression strategies across disease extent.

PURPOSE: Lumbar stenosis decompression can be delivered through corridors differing in operative footprint, perioperative variables, and resource use. How surgeons report choosing among these corridors as disease extent increases has not been mapped. This survey characterized surgeon-reported use of decompression approaches across 1-, 2-, and 3 + level lumbar stenosis scenarios.

METHODS

An international cross-sectional survey of 131 spine surgeons from 38 countries captured non-mutually-exclusive reported use of five decompression approach families (open bilateral, open unilateral over-the-top, tubular/microscopic, uniportal endoscopic, biportal endoscopic) across the three scenarios. For respondents reporting unchanged strategy at higher extents, 1-level responses were carried forward, yielding modeled full-cohort estimates.

RESULTS

Reported strategy was unchanged from 1-level to 2-level for 111/131 respondents (84.7%) and to 3 + levels for 101/131 (77.1%). Among the 30 respondents explicitly reporting strategy change for 3 + levels, open bilateral use rose from 20.0% to 53.3% and uniportal use fell from 53.3% to 0.0%. In modeled full-cohort estimates, open bilateral use rose from 27.5% to 35.1% and uniportal use fell from 37.4% to 25.2%. In exploratory models, formal endoscopic training was associated with endoscopic use at 1 level and with strategy change at 3 + levels.

CONCLUSION

Within these level-based scenarios, most surgeons reported extending their 1-level approach to multilevel disease, while a minority reported reallocating toward open bilateral decompression at three or more levels. These self-reported patterns support recording disease extent and the surgeon's 1-level approach in comparative studies, alongside corridor-specific perioperative protocols.