{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T18:48:44Z","timestamp":1793818124115,"version":"4.6.1"},"reference-count":108,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,10]]},"abstract":"\n OBJECT<\/jats:title>\n Decompression without fusion for degenerative lumbar stenosis is an effective treatment for both the pain and disability of neurogenic claudication. Iatrogenic instability following decompression may require further intervention to stabilize the spine. The authors review the incidence of postsurgical instability following lumbar decompression, and assess the impact of surgical technique as well as study design on the incidence of instability.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A comprehensive literature search was performed to identify surgical cohorts of patients with degenerative lumbar stenosis, with and without preexisting spondylolisthesis, who were treated with laminectomy or minimally invasive decompression without fusion. Data on patient characteristics, surgical indications and techniques, clinical and radiographic outcomes, and reoperation rates were collected and analyzed.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A systematic review of 24 studies involving 2496 patients was performed, assessing both open laminectomy and minimally invasive bilateral canal enlargement. Postoperative pain and functional outcomes were similar across the various studies, and postoperative radiographie instability was seen in 5.5% of patients. Instability was seen more frequently in patients with preexisting spondylolisthesis (12.6%) and in those treated with open laminectomy (12%). Reoperation for instability was required in 1.8% of all patients, and was higher for patients with preoperative spondylolisthesis (9.3%) and for those treated with open laminectomy (4.1%).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Instability following lumbar decompression is a common occurrence. This is particularly true if decompression alone is selected as a surgical approach in patients with established spondylolisthesis. This complication may occur less commonly with the use of minimally invasive techniques; however, larger prospective cohort studies are necessary to more thoroughly explore these findings.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2015.7.focus15259","type":"journal-article","created":{"date-parts":[[2015,10,1]],"date-time":"2015-10-01T03:41:45Z","timestamp":1443670905000},"page":"E9","source":"Crossref","is-referenced-by-count":122,"title":["Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts"],"prefix":"10.3171","volume":"39","author":[{"given":"Daipayan","family":"Guha","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"Heary","sequence":"additional","affiliation":[{"name":"Rutgers New Jersey Medical School, Newark, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed F.","family":"Shamji","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Toronto;"},{"name":"Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"332","article-title":"A prospective comparative study of 2 minimally invasive decompression procedures for lumbar spinal canal stenosis: unilateral laminotomy for bilateral decompression (ULBD) versus muscle-preserving interlaminar decompression (MILD)","volume":"39","author":"Arai","year":"2014"},{"key":"b2-focus15259","series-title":"Neurosurgery","first-page":"429","article-title":"Multilevel lumbar laminotomies: an alternative to laminectomy in the treatment of lumbar stenosis","volume":"26","author":"Aryanpur","year":"1990"},{"key":"b3-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"1787","article-title":"The Maine Lumbar Spine Study, Part III. 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis","volume":"21","author":"Atlas","year":"1996"},{"key":"b4-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"916","article-title":"Nationwide trends in the surgical management of lumbar spinal stenosis","volume":"38","author":"Bae","year":"2013"},{"key":"b5-focus15259","series-title":"J Neurosurg Spine","first-page":"340","article-title":"Radiographic predictors of delayed instability following decompression without fusion for degenerative grade I lumbar spondylolisthesis","volume":"18","author":"Blumenthal","year":"2013"},{"key":"b6-focus15259","series-title":"Neurosurgery","first-page":"100","article-title":"Midterm outcome after microendoscopic decompressive laminotomy for lumbar spinal stenosis: 4-year prospective study","volume":"65","author":"Castro-Menendez","year":"2009"},{"key":"b7-focus15259","series-title":"J Spinal Disord Tech","first-page":"229","article-title":"Microdecompressive laminatomy with a 5-year follow-up period for severe lumbar spinal stenosis","volume":"23","author":"Celik","year":"2010"},{"key":"b8-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"400","article-title":"Degenerative spondylolisthesis does not affect the outcome of unilateral laminotomy with bilateral decompression in patients with lumbar stenosis","volume":"39","author":"Chang","year":"2014"},{"key":"b9-focus15259","series-title":"J Am Geriatr Soc","first-page":"285","article-title":"An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations","volume":"44","author":"Ciol","year":"1996"},{"key":"b10-focus15259","series-title":"J Neurosurg Spine","first-page":"579","article-title":"Degenerative lumbar spinal stenosis: analysis of results in a series of 374 patients treated with unilateral laminotomy for bilateral microdecompression","volume":"7","author":"Costa","year":"2007"},{"key":"b11-focus15259","series-title":"Chin Med Sci J","first-page":"113","article-title":"The effect of posterior element resection on the stress distribution in the lumbar spine","volume":"10","author":"Dai","year":"1995"},{"key":"b12-focus15259","series-title":"J Bone Joint Surg Am","first-page":"1979","article-title":"Revision surgery following operations for lumbar stenosis","volume":"93","author":"Deyo","year":"2011"},{"key":"b13-focus15259","series-title":"JAMA","first-page":"1259","article-title":"Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults","volume":"303","author":"Deyo","year":"2010"},{"key":"b14-focus15259","series-title":"J Neurosurg","first-page":"793","article-title":"Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone","volume":"85","author":"Fox","year":"1996"},{"key":"b15-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"514","article-title":"Long-term outcomes of two different decompressive techniques for lumbar spinal stenosis","volume":"33","author":"Fu","year":"2008"},{"key":"b16-focus15259","series-title":"J Neurosurg Spine","first-page":"267","article-title":"Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis","volume":"1","author":"Ghogawala","year":"2004"},{"key":"b17-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"1208","article-title":"Biomechanical role of lumbar spine ligaments in flexion and extension: determination using a parallel linkage robot and a porcine model","volume":"29","author":"Gillespie","year":"2004"},{"key":"b18-focus15259","series-title":"J Bone Joint Surg Am","first-page":"802","article-title":"Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis","volume":"73","author":"Herkowitz","year":"1991"},{"key":"b19-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"E172","article-title":"A comparison of unilateral and bilateral laminotomies for decompression of L4\u2013L5 spinal stenosis","volume":"36","author":"Hong","year":"2011"},{"key":"b20-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"1754","article-title":"Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis","volume":"25","author":"Iguchi","year":"2000"},{"key":"b21-focus15259","series-title":"Minim Invasive Neurosurg","first-page":"267","article-title":"Clinical outcome of microendoscopic posterior decompression for spinal stenosis associated with degenerative spondylolisthesis--minimum 2-year outcome of 37 patients","volume":"51","author":"Ikuta","year":"2008"},{"key":"b22-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"2208","article-title":"Variation in surgical decision making for degenerative spinal disorders. Part I: lumbar spine","volume":"30","author":"Irwin","year":"2005"},{"key":"b23-focus15259","series-title":"World Neurosurg","first-page":"737","article-title":"Reoperations after surgery for lumbar spinal stenosis","volume":"75","author":"Javalkar","year":"2011"},{"key":"b24-focus15259","series-title":"N Engl J Med","first-page":"818","article-title":"Clinical practice. Lumbar spinal stenosis","volume":"358","author":"Katz","year":"2008"},{"key":"b25-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"1123","article-title":"Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis. Patient selection, costs, and surgical outcomes","volume":"22","author":"Katz","year":"1997"},{"key":"b26-focus15259","series-title":"J Spinal Disord","first-page":"404","article-title":"Clinical symptoms and surgical outcome in lumbar spinal stenosis patients with neuropathic bladder","volume":"14","author":"Kawaguchi","year":"2001"},{"key":"b27-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"E981","article-title":"Success and failure of minimally invasive decompression for focal lumbar spinal stenosis in patients with and without deformity","volume":"35","author":"Kelleher","year":"2010"},{"issue":"5 Suppl","key":"b28-focus15259","series-title":"Neurosurgery","first-page":"S146","article-title":"Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis","volume":"51","author":"Khoo","year":"2002"},{"key":"b29-focus15259","series-title":"Spine J","first-page":"1230","article-title":"Reoperation rate after surgery for lumbar spinal stenosis without spondylolisthesis: a nationwide cohort study","volume":"13","author":"Kim","year":"2013"},{"key":"b30-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"865","article-title":"Patient outcomes after minimally destabilizing lumbar stenosis decompression: the \u201cport-hole\u201d technique","volume":"25","author":"Kleeman","year":"2000"},{"key":"b31-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"1624","article-title":"Effect of facetectomy on lumbar spinal stability under sagittal plane loadings","volume":"29","author":"Lee","year":"2004"},{"key":"b32-focus15259","series-title":"J Neurosurg Spine","first-page":"359","article-title":"Chimney sublaminar decompression for degenerative lumbar spinal stenosis","volume":"4","author":"Lin","year":"2006"},{"key":"b33-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"63","article-title":"Long-term outcomes of lumbar spinal stenosis: eight-year results of the Spine Patient Outcomes Research Trial (SPORT)","volume":"40","author":"Lurie","year":"2015"},{"key":"b34-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"1","article-title":"Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial","volume":"32","author":"Malmivaara","year":"2007"},{"key":"b35-focus15259","series-title":"J Spinal Disord Tech","first-page":"39","article-title":"Unilateral laminectomy for bilateral decompression of lumbar spinal stenosis: a prospective comparative study with conservatively treated patients","volume":"15","author":"Mariconda","year":"2002"},{"key":"b36-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"382","article-title":"Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures","volume":"32","author":"Martin","year":"2007"},{"key":"b37-focus15259","series-title":"J Neurosurg Spine","first-page":"664","article-title":"Endoscope-assisted spinal decompression surgery for lumbar spinal stenosis","volume":"19","author":"Minamide","year":"2013"},{"key":"b38-focus15259","series-title":"J Neurosurg Spine","first-page":"305","article-title":"Lumbar spinal stenosis in elderly patients: is a unilateral microsurgical approach sufficient for decompression?","volume":"14","author":"Morgalla","year":"2011"},{"key":"b39-focus15259","series-title":"J Neurosurg Spine","first-page":"187","article-title":"Clinical outcome of microscopic lumbar spinous process-splitting laminectomy: clinical article","volume":"21","author":"Nomura","year":"2014"},{"key":"b40-focus15259","series-title":"Neurosurgery","first-page":"1264","article-title":"Long-term results of microsurgical treatment of lumbar spinal stenosis by unilateral laminotomy for bilateral decompression","volume":"59","author":"Oertel","year":"2006"},{"key":"b41-focus15259","series-title":"Turk Neurosurg","first-page":"178","article-title":"The effect of laminectomy on instability in the management of degenerative lumbar stenosis surgery: a retrospective radiographic assessment","volume":"17","author":"Ofluo\u011flu","year":"2007"},{"key":"b42-focus15259","series-title":"J Neurosurg Spine","first-page":"54","article-title":"Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: lumbar fusion for stenosis with spondylolisthesis","volume":"21","author":"Resnick","year":"2014"},{"key":"b43-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"1483","article-title":"Postoperative spondylolisthesis at L4\u20135. The role of facet joint morphology","volume":"18","author":"Robertson","year":"1993"},{"key":"b44-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"887","article-title":"Role of ligaments and facets in lumbar spinal stability","volume":"20","author":"Sharma","year":"1995"},{"key":"b45-focus15259","series-title":"BMC Musculoskelet Disord","first-page":"84","article-title":"Biomechanical comparison of lumbar spine instability between laminectomy and bilateral laminotomy for spinal stenosis syndrome\u2014an experimental study in porcine model","volume":"9","author":"Tai","year":"2008"},{"key":"b46-focus15259","series-title":"Neurosurgery","first-page":"567","article-title":"Quantitative outcome and radiographic comparisons between laminectomy and laminotomy in the treatment of acquired lumbar stenosis","volume":"41","author":"Thomas","year":"1997"},{"key":"b47-focus15259","series-title":"J Neurosurg Spine","first-page":"129","article-title":"Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy","volume":"3","author":"Thom\u00e9","year":"2005"},{"key":"b48-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"2707","article-title":"United States\u2019 trends and regional variations in lumbar spine surgery: 1992\u20132003","volume":"31","author":"Weinstein","year":"2006"},{"key":"b49-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"1329","article-title":"Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial","volume":"35","author":"Weinstein","year":"2010"},{"key":"b50-focus15259","series-title":"N Engl J Med","first-page":"794","article-title":"Surgical versus nonsurgical therapy for lumbar spinal stenosis","volume":"358","author":"Weinstein","year":"2008"},{"key":"b51-focus15259","series-title":"Minim Invasive Surg","first-page":"325095","article-title":"The microendoscopic decompression of lumbar stenosis: a review of the current literature and clinical results","volume":"2012","author":"Wong","year":"2012"},{"key":"b52-focus15259","series-title":"J Neurosurg Spine","first-page":"293","article-title":"Postoperative outcome after modified unilateral-approach microendoscopic midline decompression for degenerative spinal stenosis","volume":"10","author":"Yagi","year":"2009"},{"key":"b53-focus15259","series-title":"J Spinal Disord","first-page":"40","article-title":"Usefulness of Posner\u2019s definition of spinal instability for selection of surgical treatment for lumbar spinal stenosis","volume":"12","author":"Yone","year":"1999"},{"key":"b54-focus15259","series-title":"Neurosurgery","first-page":"628","article-title":"Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy: preliminary report","volume":"23","author":"Young","year":"1988"},{"key":"b1-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"332","article-title":"A prospective comparative study of 2 minimally invasive decompression procedures for lumbar spinal canal stenosis: unilateral laminotomy for bilateral decompression (ULBD) versus muscle-preserving interlaminar decompression (MILD)","volume":"39","author":"Arai","year":"2014"},{"key":"b2-focus15259","series-title":"Neurosurgery","first-page":"429","article-title":"Multilevel lumbar laminotomies: an alternative to laminectomy in the treatment of lumbar stenosis","volume":"26","author":"Aryanpur","year":"1990"},{"key":"b3-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"1787","article-title":"The Maine Lumbar Spine Study, Part III. 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis","volume":"21","author":"Atlas","year":"1996"},{"key":"b4-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"916","article-title":"Nationwide trends in the surgical management of lumbar spinal stenosis","volume":"38","author":"Bae","year":"2013"},{"key":"b5-focus15259","series-title":"J Neurosurg Spine","first-page":"340","article-title":"Radiographic predictors of delayed instability following decompression without fusion for degenerative grade I lumbar spondylolisthesis","volume":"18","author":"Blumenthal","year":"2013"},{"key":"b6-focus15259","series-title":"Neurosurgery","first-page":"100","article-title":"Midterm outcome after microendoscopic decompressive laminotomy for lumbar spinal stenosis: 4-year prospective study","volume":"65","author":"Castro-Menendez","year":"2009"},{"key":"b7-focus15259","series-title":"J Spinal Disord Tech","first-page":"229","article-title":"Microdecompressive laminatomy with a 5-year follow-up period for severe lumbar spinal stenosis","volume":"23","author":"Celik","year":"2010"},{"key":"b8-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"400","article-title":"Degenerative spondylolisthesis does not affect the outcome of unilateral laminotomy with bilateral decompression in patients with lumbar stenosis","volume":"39","author":"Chang","year":"2014"},{"key":"b9-focus15259","series-title":"J Am Geriatr Soc","first-page":"285","article-title":"An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations","volume":"44","author":"Ciol","year":"1996"},{"key":"b10-focus15259","series-title":"J Neurosurg Spine","first-page":"579","article-title":"Degenerative lumbar spinal stenosis: analysis of results in a series of 374 patients treated with unilateral laminotomy for bilateral microdecompression","volume":"7","author":"Costa","year":"2007"},{"key":"b11-focus15259","series-title":"Chin Med Sci J","first-page":"113","article-title":"The effect of posterior element resection on the stress distribution in the lumbar spine","volume":"10","author":"Dai","year":"1995"},{"key":"b12-focus15259","series-title":"J Bone Joint Surg Am","first-page":"1979","article-title":"Revision surgery following operations for lumbar stenosis","volume":"93","author":"Deyo","year":"2011"},{"key":"b13-focus15259","series-title":"JAMA","first-page":"1259","article-title":"Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults","volume":"303","author":"Deyo","year":"2010"},{"key":"b14-focus15259","series-title":"J Neurosurg","first-page":"793","article-title":"Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone","volume":"85","author":"Fox","year":"1996"},{"key":"b15-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"514","article-title":"Long-term outcomes of two different decompressive techniques for lumbar spinal stenosis","volume":"33","author":"Fu","year":"2008"},{"key":"b16-focus15259","series-title":"J Neurosurg Spine","first-page":"267","article-title":"Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis","volume":"1","author":"Ghogawala","year":"2004"},{"key":"b17-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"1208","article-title":"Biomechanical role of lumbar spine ligaments in flexion and extension: determination using a parallel linkage robot and a porcine model","volume":"29","author":"Gillespie","year":"2004"},{"key":"b18-focus15259","series-title":"J Bone Joint Surg Am","first-page":"802","article-title":"Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis","volume":"73","author":"Herkowitz","year":"1991"},{"key":"b19-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"E172","article-title":"A comparison of unilateral and bilateral laminotomies for decompression of L4\u2013L5 spinal stenosis","volume":"36","author":"Hong","year":"2011"},{"key":"b20-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"1754","article-title":"Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis","volume":"25","author":"Iguchi","year":"2000"},{"key":"b21-focus15259","series-title":"Minim Invasive Neurosurg","first-page":"267","article-title":"Clinical outcome of microendoscopic posterior decompression for spinal stenosis associated with degenerative spondylolisthesis--minimum 2-year outcome of 37 patients","volume":"51","author":"Ikuta","year":"2008"},{"key":"b22-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"2208","article-title":"Variation in surgical decision making for degenerative spinal disorders. Part I: lumbar spine","volume":"30","author":"Irwin","year":"2005"},{"key":"b23-focus15259","series-title":"World Neurosurg","first-page":"737","article-title":"Reoperations after surgery for lumbar spinal stenosis","volume":"75","author":"Javalkar","year":"2011"},{"key":"b24-focus15259","series-title":"N Engl J Med","first-page":"818","article-title":"Clinical practice. Lumbar spinal stenosis","volume":"358","author":"Katz","year":"2008"},{"key":"b25-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"1123","article-title":"Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis. Patient selection, costs, and surgical outcomes","volume":"22","author":"Katz","year":"1997"},{"key":"b26-focus15259","series-title":"J Spinal Disord","first-page":"404","article-title":"Clinical symptoms and surgical outcome in lumbar spinal stenosis patients with neuropathic bladder","volume":"14","author":"Kawaguchi","year":"2001"},{"key":"b27-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"E981","article-title":"Success and failure of minimally invasive decompression for focal lumbar spinal stenosis in patients with and without deformity","volume":"35","author":"Kelleher","year":"2010"},{"issue":"5 Suppl","key":"b28-focus15259","series-title":"Neurosurgery","first-page":"S146","article-title":"Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis","volume":"51","author":"Khoo","year":"2002"},{"key":"b29-focus15259","series-title":"Spine J","first-page":"1230","article-title":"Reoperation rate after surgery for lumbar spinal stenosis without spondylolisthesis: a nationwide cohort study","volume":"13","author":"Kim","year":"2013"},{"key":"b30-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"865","article-title":"Patient outcomes after minimally destabilizing lumbar stenosis decompression: the \u201cport-hole\u201d technique","volume":"25","author":"Kleeman","year":"2000"},{"key":"b31-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"1624","article-title":"Effect of facetectomy on lumbar spinal stability under sagittal plane loadings","volume":"29","author":"Lee","year":"2004"},{"key":"b32-focus15259","series-title":"J Neurosurg Spine","first-page":"359","article-title":"Chimney sublaminar decompression for degenerative lumbar spinal stenosis","volume":"4","author":"Lin","year":"2006"},{"key":"b33-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"63","article-title":"Long-term outcomes of lumbar spinal stenosis: eight-year results of the Spine Patient Outcomes Research Trial (SPORT)","volume":"40","author":"Lurie","year":"2015"},{"key":"b34-focus15259","series-title":"Spine (Phila Pa 1976)","first-page":"1","article-title":"Surgical or nonoperative treatment for lumbar spinal stenosis? 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