Every year an estimated 90 of 100 000 persons older than 60 years undergo lumbar fusion surgery.1 The diagnosis of lumbar spinal stenosis, defined as “a clinical syndrome of buttock or lower extremity pain, which may occur with or without back pain, associated with diminished space available for the neural and vascular elements in the lumbar spine,”2 is an important driver of the exponential increase in this procedure. Most surgeons rely on imaging for diagnosing spinal stenosis and for determining the need for surgery. However, the assumption that radiological measures confirm the diagnosis of the clinical syndrome of stenosis has been questioned. Without a clear diagnostic standard, a management strategy that minimizes the potential of harm from an incorrect diagnosis needs to be developed.
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