THE SINGLE-STAGED DECOMPRESSIVE SURGERY FOR TANDEM SPINAL STENOSIS: ANALYSIS OF THE OUTCOMES
DOI:
https://doi.org/10.22159/ajpcr.2024v17i8.52209Keywords:
Spinal stenosis, Cervical, Lumbar, Dorsal, Simultaneous decompressionAbstract
Objective: When the spinal canal diameter narrows in at least two separate areas of the spine, it is referred to as tandem spinal stenosis (TSS), mostly seen in cervical and lumbar regions and rarely in the thoracic region. This clinical entity can present as severe cervical myelopathy, lower extremity symptoms, or can be completely asymptomatic. The treatment protocol for operative intervention is not well-defined in the literature.
Methods: We examined information from 50 TSS patients who underwent surgery between August 2015 and August 2023. We looked at the patient’s age, gender, comorbidities, length of stay in the hospital, total estimated blood loss, and surgery time. Complications were also looked at, along with the pre-operative and post-operative modified Japanese Orthopedic Association (mJOA), and Oswestry disability index (ODI) scores.
Results: For the disease types, 100 TSS cases were included. All cases had lumbar canal stenosis, with 28 (28%) cases having associated dorsal spinal canal stenosis, and 72 (72%) cases having cervical degenerative spondylosis. Fusion was required in 78 cases (78%). Post-operative follow-up recording was started 1 month following surgery till 3 years. The average post-operative mJOA score was 17.6 and the average ODI was 12.4.
Conclusions: Decompressions can be performed in stages or simultaneously to effectively control TSS. In addition to being safe and efficient, one-stage simultaneous decompression has the benefit of shortening hospital stays without requiring more surgery or blood loss. Nonetheless, it is advised that surgical indications be closely monitored and reserved for younger patients with fewer comorbidities.
Downloads
References
Teng P, Papatheodorou C. Combined cervical and lumbar spondylosis. Arch Neurol. 1964 Mar;10:298-307. doi: 10.1001/ archneur.1964.00460150068007, PMID 14106986
Hilibrand AS, Rand N. Degenerative lumbar stenosis: Diagnosis and management. J Am Acad Orthop Surg. 1999;7(4):239-49. doi: 10.5435/00124635-199907000-00004, PMID 10434078
Lee BH, Moon SH, Suk KS, Kim HS, Yang JH, Lee HM. Lumbar spinal stenosis: Pathophysiology and treatment principle: A narrative review. Asian Spine J. 2020;14(5):682-93. doi: 10.31616/asj.2020.0472, PMID 33108834
Jensen RK, Jensen TS, Koes B, Hartvigsen J. Prevalence of lumbar spinal stenosis in general and clinical populations: A systematic review and meta-analysis. Eur Spine J. 2020;29(9):2143-63. doi: 10.1007/ s00586-020-06339-1, PMID 32095908
Sengupta DK, Herkowitz HN. Lumbar spinal stenosis. Treatment strategies and indications for surgery. Orthop Clin North Am. 2003;34(2):281-95. doi: 10.1016/s0030-5898(02)00069-x, PMID 12914268
Ahorukomeye P, Saniei S, Pennacchio CA, Kuo A, Mlis AC, Cheng CW, et al. Outcomes in surgical treatment for tandem spinal stenosis: Systematic literature review. Spine J. 2022;22(11):1788-800. doi: 10.1016/j.spinee.2022.07.088, PMID 35843535
Cao J, Gao X, Yang Y, Lei T, Shen Y, Wang L, et al. Simultaneous or staged operation for tandem spinal stenosis: Surgical strategy and efficacy comparison. J Orthop Surg Res. 2021;16(1):214. doi: 10.1186/ s13018-021-02357-x, PMID 33761964
Bai Q, Wang Y, Zhai J, Wu J, Zhang Y, Zhao Y. Current understanding of tandem spinal stenosis: Epidemiology, diagnosis, and surgical strategy. EFORT Open Rev. 2022;7(8):587-98. doi: 10.1530/EOR-22- 0016, PMID 35924651
Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66(8):271-3. PMID 6450426
Kato S, Oshima Y, Oka H, Chikuda H, Takeshita Y, Miyoshi K, et al. Comparison of the Japanese Orthopaedic Association (JOA) score and modified JOA (mJOA) score for the assessment of cervical myelopathy: A multicenter observational study. PLoS One. 2015;10(4):e0123022. doi: 10.1371/journal.pone.0123022, PMID 25837285 [published correction appears in PLoS One. 2015 May 11;10(5):e0128392. doi: 10.1371/journal.pone.0128392, PMID 25962061
Chiles BW 3rd, Leonard MA, Choudhri HF, Cooper PR. Cervical spondylotic myelopathy: Patterns of neurological deficit and recovery after anterior cervical decompression. Neurosurgery. 1999;44(4):762- 9; discussion 9-70. doi: 10.1097/00006123-199904000-00041, PMID 10201301
Overley SC, Kim JS, Gogel BA, Merrill RK, Hecht AC. Tandem spinal stenosis: A systematic review. JBJS Rev. 2017;5(9):e2. doi: 10.2106/ JBJS.RVW.17.00007, PMID 28872572
Hsieh CH, Huang TJ, Hsu RW. Tandem spinal stenosis: Clinical diagnosis and surgical treatment. Changgeng Yi Xue Za Zhi. 1998;21(4):429-35. PMID 10074729
Epstein NE, Epstein JA, Carras R, Murthy VS, Hyman RA. Coexisting cervical and lumbar spinal stenosis: Diagnosis and management. Neurosurgery. 1984;15(4):489-96. doi: 10.1227/00006123-198410000- 00003, PMID 6493458
Luo CA, Kaliya-Perumal AK, Lu ML, Chen LH, Chen WJ, Niu CC. Staged surgery for tandem cervical and lumbar spinal stenosis: Which should be treated first? Eur Spine J. 2019;28(1):61-8. doi: 10.1007/ s00586-018-5795-6, PMID 30328532
Naderi S, Mertol T. Simultaneous cervical and lumbar surgery for combined symptomatic cervical and lumbar spinal stenosis. J Spinal Disord Tech. 2002;15(3):229-31; discussion 231. doi: 10.1097/00024720-200206000-00011, PMID 12131425
Kikuike K, Miyamoto K, Hosoe H, Shimizu K. One-staged combined cervical and lumbar decompression for patients with tandem spinal stenosis on cervical and lumbar spine: Analyses of clinical outcomes with minimum 3 years follow-up. J Spinal Disord Tech. 2009;22(8):593- 601. doi: 10.1097/BSD.0b013e3181929cbd, PMID 19956034
Lu C, Qiu H, Huang X, Yang X, Liu D, Zhang S, et al. Meta-analysis of simultaneous versus staged decompression of stenotic regions in patients with tandem spinal stenosis. World Neurosurg. 2023;170:e441- 54. doi: 10.1016/j.wneu.2022.11.028, PMID 36396060
Abbas Z, Asati S, Kundnani VG, Jain S, Prakash R, Raut S. Surgical outcomes of single stage surgery for Tandem spinal stenosis (TSS) in elderly and younger patients: A comparative study. J Clin Orthop Trauma. 2021;17:157-62. doi: 10.1016/j.jcot.2021.03.007, PMID 33854943
Singrakhia MD, Malewar NR, Deshmukh S, Deshmukh SS. Prospective analysis of functional outcome of single-stage surgical treatment for symptomatic tandem spinal stenosis. Indian J Orthop. 2019;53(2):315- 23. doi: 10.4103/ortho.IJOrtho_316_17, PMID 30967703
Published
How to Cite
Issue
Section
Copyright (c) 2024 Pradeep Kumar Jain, Nishchith Sudarshan, Pranoy Hegde, ashirwad Karigoudar, Madhu C Shivaswamy
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.
