Tandem spinal stenosis (TSS) is an entity which refers to spinal canal diameter narrowing in at least two distinct regions of the spine. When symptomatic, management of TSS is controversial. In this study, we present a consecutive series of patients with symptomatic TSS and report diagnostic and surgical challenges. We retrospectively reviewed a consecutive series of N = 8 patients with symptomatic TSS who underwent surgical treatment in at least one region of the spine. Patients presented with multiple complaints, including neurogenic claudication, progressive gait disturbances, and signs of radiculopathy and/or myelopathy, among others. Modified Japanese Orthopedic Association (mJOA) and Oswestry Low Back Pain Disability Questionnaire (ODI) were obtained in pre- and postoperative period. Electroneurophysiological examinations were limited to patients whose clinical and radiological signs were not sufficient to determine which region was more affected. From 2015 to 2018, we included N = 8 consecutive patients with TSS who underwent surgery by a staged approach. The stenosis was localized in the cervical and lumbar region in six patients (75%) and in the cervical, dorsal, and lumbar level (triple TSS) in two patients (25%). Four patients (50%) underwent cervical and lumbar surgery, two (25%) underwent cervical surgery alone, and two (25%) were operated in all three involved regions. Surgical treatment allowed an improvement of the mean mJOA score (from 12.5/17 to 15/17) and mean ODI score (from 41 to 28%). TSS represents a clinical, diagnostic, and surgical challenge. We recommend to systematically obtain electrophysiological and radiological examinations and then to perform a staged surgery, beginning at the most symptomatic region.
Tandem spinal stenosis Motor- and sensory-evoked potentials Staged surgery Simultaneous surgery Myelopathy
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Conflict of interest
Enrico Tessitore received training fees from Spineart, Medtronic, Depuy Synthes, Nuvasive and consultancy fees from Brainlab. All other authors declare that they have no conflict of interest.
Informed consent was obtained.
Teng P, Papatheodorou C (1964) Combined cervical and lumbar spondylosis. Arch Neurol 10:298–307CrossRefGoogle Scholar
Dagi TF, Tarkington MA, Leech JJ (1987) Tandem lumbar and cervical spinal stenosis. Natural history, prognostic indices, and results after surgical decompression. J Neurosurg 66:842–849CrossRefGoogle Scholar
Kikuike K, Miyamoto K, Hosoe H, Shimizu K (2009) 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 22:593–601CrossRefGoogle Scholar
Schaffer JC, Raudenbush BL, Molinari C, Molinari RW (2015) Symptomatic triple-region spinal stenosis treated with simultaneous surgery: case report and review of the literature. Global Spine J 5(6):513–521CrossRefGoogle Scholar
Tsutsumimoto T, Shimogata M, Yui M, Ohta H, Misawa H (2012) The natural history of asymptomatic lumbar canal stenosis in patients undergoing surgery for cervical myelopathy. J Bone Joint Surg Br 94(3):378–384CrossRefGoogle Scholar
Fushimi K, Miyamoto K, Hioki A, Hosoe H, Takeuchi A, Shimizu K (2013) Neurological deterioration due to missed thoracic spinal stenosis after decompressive lumbar surgery: a report of six cases of tandem thoracic and lumbar spinal stenosis. Bone Joint J 95-B:1388–1391CrossRefGoogle Scholar
Boccanera L, Laus M (1987) Cauda equina syndrome following lumbar spinal stenosis surgery. Spine (Phila Pa 1976) 12:712–715CrossRefGoogle Scholar
LaBan MM, Green ML (2004) Concurrent (tandem) cervical and lumbar spinal stenosis: a 10-yr review of 54 hospitalized patients. Am J Phys Med Rehabil 83(3):187–190CrossRefGoogle Scholar
Uehara M, Tsutsumimoto T, Yui M, Ohta H, Ohba H, Misawa H (2016) Single-stage surgery for compressive thoracic myelopathy associated with compressive cervical myelopathy and/or lumbar spinal canal stenosis. Eur Spine J 25(6):1904–1911CrossRefGoogle Scholar
Tavy DL, Franssen H, Keunen RW, Wattendorff AR, Hekster RE, Van Huffelen AC (1999) Motor and somatosensory evoked potentials in asymptomatic spondylotic cord compression. Muscle Nerve 22(5):628–634CrossRefGoogle Scholar
Eskander MS, Aubin ME, Drew JM, Eskander JP, Balsis SM, Eck J, Lapinsky AS, Connolly PJ (2011) Is there a difference between simultaneous or staged decompressions for combined cervical and lumbar stenosis? J Spinal Disord Tech 24(6):409–413CrossRefGoogle Scholar
Hu PP, Yu M, Liu XG, Liu ZJ, Jiang L (2017) Surgeries for patients with tandem spinal stenosis in cervical and thoracic spine: combined or staged surgeries? World Neurosurg 107:115–123CrossRefGoogle Scholar
Luo CA, Kaliya-Perumal AK, Lu ML, Chen LH, Chen WJ, Niu CC (2019) Staged surgery for tandem cervical and lumbar spinal stenosis: which should be treated first? Eur Spine J 28(1):61–68CrossRefGoogle Scholar
Hsieh CH, Huang TJ, Hsu RW (1998) Tandem spinal stenosis: clinical diagnosis and surgical treatment. Changgeng Yi Xue Za Zhi 21(4):429–435Google Scholar