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Surgical strategy for non-continuous thoracic spinal stenosis: one- or two-stage surgery?

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Abstract

Purpose

Non-continuous thoracic spinal stenosis (NTSS) is a rare disease, but it is a challenging clinical entity for spine surgeons. However, few studies have focused on its treatment. Therefore, the purpose of this study was to provide surgical treatment guidelines for it by comparing the clinical outcomes of different surgical approaches.

Methods

Patients who underwent thoracic decompression surgery for two diseased segments with two incisions (normal segments ≥ 3) between January 2010 and December 2018 were included. Among these patients, nine were treated with posterior decompression (PD) and circumferential decompression (CD) procedures in one-stage surgery (group A), 14 with PD and CD procedures in two-stage surgery (group B), 36 patients with PD procedures in one-stage surgery and 15 with PD procedures in two-stage surgery (group D). Medical records, operative time, blood loss and complications were reviewed. Neurologic status was assessed by the modified Japanese Orthopaedic Association scale for thoracic myelopathy.

Results

Groups A, B, C and D were followed for 54.11 ± 20.51 months, 49.36 ± 29.30 months, 49.94 ± 31.94 months and 39.93 ± 26.18 months, respectively. When comparing groups A and B, operative time, blood loss and length of stay in hospital were significantly less in group A. However, the average recovery rate in group B was significantly higher than that in group A. In regard to groups C and D, group C showed a significantly shorter length of stay in hospital and lower rate of post-operative neurological deterioration. At final follow-up, groups C and D showed similar average recovery rates.

Conclusion

Different surgical procedures are suitable for different types of NTSS. For patients with NTSS mainly caused by posterior compression, PD via laminectomy in one-stage with two incisions can achieve satisfying clinical outcomes. Staged surgery, including CD and PD procedures, is recommended for patients with NTSS mainly caused by anterior compression.

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Data availability

The data used and analyzed during the current study was available from the corresponding author on reasonable request.

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Funding

This work was supported by the fellowship of China Postdoctoral Science Foundation (No.2020M670002ZX).

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Authors and Affiliations

  1. Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, China

    Longjie Wang, Hui Wang, Zhongqiang Chen, Chuiguo Sun & Weishi Li

  2. Beijing Key Laboratory of Spinal Disease Research, Beijing, China

    Weishi Li

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  1. Longjie Wang
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  2. Hui Wang
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  4. Chuiguo Sun
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  5. Weishi Li
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Contributions

Weishi Li contributed to the study conception and design. Data collection and analysis were performed by Longjie Wang and Hui Wang. Zhongqiang Chen and Chuiguo Sun participated in design and coordination and helped to draft the manuscript. The article was written by Longjie Wang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Weishi Li.

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Conflict of interest

Longjie Wang has received funding from the fellowship of China Postdoctoral Science Foundation (No.2020M670002ZX). Hui Wang, Zhongqiang Chen, Chuiguo Sun and Weishi Li declare they have no financial interests.

Ethical approval

This study was approved by the Peking University Third hospital ethics committee. For this type of study, formal consent is not required. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Wang, L., Wang, H., Chen, Z. et al. Surgical strategy for non-continuous thoracic spinal stenosis: one- or two-stage surgery?. International Orthopaedics (SICOT) 45, 1871–1880 (2021). https://doi.org/10.1007/s00264-020-04913-2

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  • DOI: https://doi.org/10.1007/s00264-020-04913-2

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