{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T22:25:34Z","timestamp":1788128734942,"version":"build-2803163510"},"reference-count":104,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,12,2]],"date-time":"2018-12-02T00:00:00Z","timestamp":1543708800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Unrestricted educational grant to the West Virginia Society of Interventional Pain Physicians from Vertos Medical"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Lumbar spinal stenosis (\n                      <jats:styled-content style=\"fixed-case\">LSS<\/jats:styled-content>\n                      ) can lead to compression of neural elements and manifest as low back and leg pain.\n                      <jats:styled-content style=\"fixed-case\">LSS<\/jats:styled-content>\n                      has traditionally been treated with a variety of conservative (pain medications, physical therapy, epidural spinal injections) and invasive (surgical decompression) options. Recently, several minimally invasive procedures have expanded the treatment options.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The Lumbar Spinal Stenosis Consensus Group convened to evaluate the peer\u2010reviewed literature as the basis for making minimally invasive spine treatment (\n                      <jats:styled-content style=\"fixed-case\">MIST<\/jats:styled-content>\n                      ) recommendations. Eleven consensus points were clearly defined with evidence strength, recommendation grade, and consensus level using U.S. Preventive Services Task Force criteria. The Consensus Group also created a treatment algorithm. Literature searches yielded 9 studies (2 randomized controlled trials [\n                      <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>\n                      s]; 7 observational studies, 4 prospective and 3 retrospective) of minimally invasive spine treatments, and 1\n                      <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>\n                      for spacers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The\n                      <jats:styled-content style=\"fixed-case\">LSS<\/jats:styled-content>\n                      treatment choice is dependent on the degree of stenosis; spinal or anatomic level; architecture of the stenosis; severity of the symptoms; failed, past, less invasive treatments; previous fusions or other open surgical approaches; and patient comorbidities. There is Level I evidence for percutaneous image\u2010guided lumbar decompression as superior to lumbar epidural steroid injection, and 1\n                      <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>\n                      supported spacer use in a noninferiority study comparing 2 spacer products currently available.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      MISTs should be used in a judicious and algorithmic fashion to treat\n                      <jats:styled-content style=\"fixed-case\">LSS<\/jats:styled-content>\n                      , based on the evidence of efficacy and safety in the peer\u2010reviewed literature. The\n                      <jats:styled-content style=\"fixed-case\">MIST<\/jats:styled-content>\n                      Consensus Group recommend that these procedures be used in a multimodal fashion as part of an evidence\u2010based decision algorithm.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/papr.12744","type":"journal-article","created":{"date-parts":[[2018,10,28]],"date-time":"2018-10-28T01:14:36Z","timestamp":1540689276000},"page":"250-274","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":65,"title":["The\n                    <scp>MIST<\/scp>\n                    Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment"],"prefix":"10.1111","volume":"19","author":[{"given":"Timothy R.","family":"Deer","sequence":"first","affiliation":[{"name":"Center for Pain Relief Charleston West Virginia 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