Chi-An Luo1, Arun-Kumar Kaliya-Perumal1,2, Meng-Ling Lu3, Lih-Huei Chen1, Wen-Jer Chen1,4, Chi-Chien Niu5. 1. Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, No. 5, Fusing Street, Gueishan, Taoyuan, 333, Taiwan. 2. Department of Orthopaedic Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Affiliated to the Tamil Nadu Dr. MGR Medical University, Chennai, Tamil Nadu, India. 3. Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital, Kaohsiung, 833, Taiwan. 4. Department of Orthopaedic Surgery, Chung Shan Hospital, Taipei, 106, Taiwan. 5. Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, No. 5, Fusing Street, Gueishan, Taoyuan, 333, Taiwan. niuchien@adm.cgmh.org.tw.
Abstract
PURPOSE: Tandem spinal stenosis (TSS) refers to lumbar and cervical spinal canal stenosis. Staged surgery is often chosen, but sometimes, mere decompression of one stenosis is adequate to relieve symptoms. Therefore, we intend to analyze whether starting with the cervical or the lumbar region is the most logical option. METHODS: We retrospectively reviewed the data of 47 patients with TSS, having first-stage decompression for the most symptomatic stenosis, and classified into two groups (Group A: lumbar decompression first, Group B: cervical decompression first). Postoperative outcomes were analyzed for at least 2 years, and they were cautiously watched for symptoms of the non-operated stenosis; if such symptoms were debilitating, second-stage surgery for the non-operated stenosis was done. RESULTS: The demographic characteristics of Group A (n = 11) and Group B (n = 36) were comparable. One patient (9%) in Group A and 25 patients (67%) in Group B had resolution of symptoms and good functional recovery. The need for a second-stage surgery for the non-operated stenosis was significantly high (p = 0.001) among patients in Group A. They suffered a significant worsening of both the mJOA score and the Nurick's grade; whereas, patients in Group B experienced staged improvement of both scales. CONCLUSION: First-stage surgery for the cervical stenosis significantly lowers the need of the second-stage surgery. In contrast, if lumbar stenosis was treated first, a dramatic exacerbation of the symptoms related to the cervical stenosis can occur soon. Therefore, treatment of cervical stenosis first seems to be more appropriate. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: Tandem spinal stenosis (TSS) refers to lumbar and cervical spinal canal stenosis. Staged surgery is often chosen, but sometimes, mere decompression of one stenosis is adequate to relieve symptoms. Therefore, we intend to analyze whether starting with the cervical or the lumbar region is the most logical option. METHODS: We retrospectively reviewed the data of 47 patients with TSS, having first-stage decompression for the most symptomatic stenosis, and classified into two groups (Group A: lumbar decompression first, Group B: cervical decompression first). Postoperative outcomes were analyzed for at least 2 years, and they were cautiously watched for symptoms of the non-operated stenosis; if such symptoms were debilitating, second-stage surgery for the non-operated stenosis was done. RESULTS: The demographic characteristics of Group A (n = 11) and Group B (n = 36) were comparable. One patient (9%) in Group A and 25 patients (67%) in Group B had resolution of symptoms and good functional recovery. The need for a second-stage surgery for the non-operated stenosis was significantly high (p = 0.001) among patients in Group A. They suffered a significant worsening of both the mJOA score and the Nurick's grade; whereas, patients in Group B experienced staged improvement of both scales. CONCLUSION: First-stage surgery for the cervical stenosis significantly lowers the need of the second-stage surgery. In contrast, if lumbar stenosis was treated first, a dramatic exacerbation of the symptoms related to the cervical stenosis can occur soon. Therefore, treatment of cervical stenosis first seems to be more appropriate. These slides can be retrieved under Electronic Supplementary Material.
Entities:
Keywords:
Spondylosis; Staged operation; Surgical sequence; Tandem spinal stenosis