Degenerative Lumbar Spine Stenosis Consensus Conference: the Italian Job. Recommendations of the Spinal Section of Italian Society of Neurosurgery

none28In the modern era evidence-based medicine, guidelines and recommendations represent a key-point of daily activity. The Spinal Section of the Italian Society of Neurosurgery introduced some recommendations regarding Degenerative Lumbar Spine Stenosis based on those of the Spine Committee of World Federation of Neurosurgical Societies, revising them on the basis of Italian common practice. Background: In the modern era evidence-based medicine, guidelines and recommendations represent a key-point of daily activity. The Spinal Section of the Italian Society of Neurosurgery introduced some recommendations regarding Degenerative Lumbar Spine Stenosis based on those of the Spine Committee of World Federation of Neurosurgical Societies, revising them on the basis of Italian common practice. Methods: In June 2019, a Committee of 21 spine surgeons met in Rome to validate the recommendations of the WFNS. Furthermore, they decided to review the ones that did not reach a consensus to create Italian Recommendations on Degenerative Lumbar Spine Stenosis. A literature review of the last ten years was performed and the statements were voted using the Delphi method. Results: 41 statements were discussed and 7 statements were voted again to reach a consensus with respect to those of the WFNS. A total of 40 statements reached a consensus, of which 36 reached a positive consensus and 4 a negative consensus, while no consensus was reached in 1 case. Conclusions: Conservative multimodal therapy, tailored on the patient, is a reasonable and effective first option choice for the treatment of LSS patients with tolerable moderate symptoms. Surgical treatment is reserved for symptomatic patients non-responding to conservative treatment or with neurological deficits. The best surgical technique to use depends on personal experience; modern MISS techniques are equivalent to open decompressive surgery with some advantages and higher cost-effectiveness. Fusion surgery and mobility preserving surgery only have a marginal role in the treatment of DLSS without instability.noneCosta, Francesco; Innocenzi, Gualtiero; Guida, Franco; Agrillo, Umberto; Barbagallo, Giuseppe; Bocchetti, Antonio; Bongetta, Daniele; Cappelletto, Barbara; Certo, Francesco; Cimatti, Marco; Cioffi, Valentina; Dobran, Mauro; Domenicucci, Maurizio; Guizzardi, Giancarlo; Guizzardi, Giulia; Landi, Alessandro; Marotta, Nicola; Marzetti, Francesco; Montano, Nicola; Anania, Carla D; Nina, Pierpaolo; Quaglietta, Paolo; Rispoli, Rossella; Somma, Teresa; Squillante, Eleonora; Visocchi, Massimiliano; Vitali, Matteo; Vitiello, VincenzoCosta, Francesco; Innocenzi, Gualtiero; Guida, Franco; Agrillo, Umberto; Barbagallo, Giuseppe; Bocchetti, Antonio; Bongetta, Daniele; Cappelletto, Barbara; Certo, Francesco; Cimatti, Marco; Cioffi, Valentina; Dobran, Mauro; Domenicucci, Maurizio; Guizzardi, Giancarlo; Guizzardi, Giulia; Landi, Alessandro; Marotta, Nicola; Marzetti, Francesco; Montano, Nicola; Anania, Carla D; Nina, Pierpaolo; Quaglietta, Paolo; Rispoli, Rossella; Somma, Teresa; Squillante, Eleonora; Visocchi, Massimiliano; Vitali, Matteo; Vitiello, Vincenz

Unruptured Aneurysms Italian Study (UAIS) background and method

Treatment of unruptured cerebral aneurysms still represents an unsettled question in neurosurgical and neuroradiological communities. Although nowadays the indication for treatment have become relatively clear, indeed uncertainity remains for what concerns the proper treatment modality (surgical or endovascular) in terms of both the risk and the mid and long-term efficacy of the two procedures. The "Unruptured Aneurysms Italian Study" is a cooperative prospective study which aims to delineate the "State of the Art" in a nation based population. It has been designed: 1) to depict the nationwide modality of treatment of Unruptured Aneurysms, 2) to assess in the most objective way the overall treatment-related mortality and morbidity as well as the surgical and endovascular risk in the respective patient populations (it is not a surgical versus endovascular study) and 3) to asses the efficacy of the different procedures in the mid and long term periods. The study started on June 2003 and to June 2006, 637 patients have been enrolled. The study will end when the 1000th patient is enrolled