Skip to main content

The prevalence of tandem spinal stenosis and its characteristics in a population-based MRI study: The Wakayama Spine Study

Abstract

Purpose

Tandem spinal stenosis (TSS) is a condition of combined spinal stenosis in the cervical and lumbar regions. The purpose of this study was to determine the prevalence of radiographic TSS and its association with developmental canal stenosis (DCS). The second purpose was to investigate the extent to which radiographic TSS is associated with cervical myelopathy and symptomatic LSS.

Methods

We recruited 1011 (336 men and 675 women) participants in this population-based study. After excluding those with a pacemaker, a history of cervical or lumbar surgery, disqualification, the MRI data of whole spine was analysed in 931 (mean, 67.3 years) participants. Cervical cord compression (CCC) and radiographic lumbar spinal stenosis (LSS) were evaluated by MRI. The canal-to-body ratio was also measured by plain X-ray. DCS was diagnosed as canal-to-body ratio <0.75. The diagnosis of cervical myelopathy and symptomatic LSS was made by presentation of both symptoms and radiographic compression using MRI.

Results

The prevalence of CCC was 24.7%, that of radiographic LSS was 30.2%, and that of radiographic TSS was 11.0% (men, 14.1%; women, 9.4%). The prevalence of TSS was significantly higher in the DCS group than in the non-DCS group (p < 0.001). Among the participants with radiographic TSS, the prevalence of cervical myelopathy and symptomatic LSS was 9.8 and 18.6%, respectively. The coexisting cervical myelopathy and symptomatic LSS was 6.1% in the participants with LSS.

Conclusions

The present study is the first population-based study to clarify TSS characteristic using whole-spine MRI.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. Dagi TF, Tarkington MA, Leech JJ (1987) Tandem lumbar and cervical spinal stenosis. Natural history, prognostic indices, and results after surgical decompression. J Neurosurg 66:842–849

    CAS  Article  PubMed  Google Scholar 

  2. 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 83:187–190

    Article  PubMed  Google Scholar 

  3. Yone K, Sakou T, Ijiri K (1992) Preoperative and postoperative magnetic resonance image evaluations of the spinal cord in cervical myelopathy. Spine 17:S388–S392

    CAS  Article  PubMed  Google Scholar 

  4. Keiper MD, Zimmerman RA, Bilaniuk LT (1998) MRI in the assessment of the supportive soft tissues of the cervical spine in acute trauma in children. Neuroradiology 40:359–363

    CAS  Article  PubMed  Google Scholar 

  5. Iizuka H, Takahashi K, Tanaka S, Kawamura K, Okano Y, Oda H (2012) Predictive factors of cervical spondylotic myelopathy in patients with lumbar spinal stenosis. Arch Orthop Trauma Surg 132:607–611

    Article  PubMed  Google Scholar 

  6. Lee SH, Kim KT, Suk KS, Lee JH, Shin JH, So DH, Kwack YH (2010) Asymptomatic cervical cord compression in lumbar spinal stenosis patients: a whole spine magnetic resonance imaging study. Spine 35:2057–2063

    Article  PubMed  Google Scholar 

  7. Bajwa NS, Toy JO, Young EY, Ahn NU (2012) Is congenital bony stenosis of the cervical spine associated with lumbar spine stenosis? An anatomical study of 1072 human cadaveric specimens. J Neurosurg Spine 17:24–298

    Article  PubMed  Google Scholar 

  8. Ishimoto Y, Yoshimura N, Muraki S, Yamada H, Nagata K, Hashizume H, Takiguchi N, Minamide A, Oka H, Kawaguchi H, Nakamura K, Akune T, Yoshida M (2012) Prevalence of symptomatic lumbar spinal stenosis and its association with physical performance in a population-based cohort in Japan: the Wakayama Spine Study. Osteoarthr Cartil 20:1103–1108

    CAS  Article  PubMed  Google Scholar 

  9. Nagata K, Yoshimura N, Muraki S, Hashizume H, Ishimoto Y, Yamada H, Takiguchi N, Nakagawa Y, Oka H, Kawaguchi H, Nakamura K, Akune T, Yoshida M (2012) Prevalence of cervical cord compression and its association with physical performance in a population-based cohort in Japan: The Wakayama Spine Study. Spine 37:1892–1898

    Article  PubMed  Google Scholar 

  10. Ishimoto Y, Yoshimura N, Muraki S, Yamada H, Nagata K, Hashizume H, Takiguchi N, Minamide A, Oka H, Kawaguchi H, Nakamura K, Akune T, Yoshida M (2013) Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: The Wakayama Spine Study. Osteoarthr Cartil 21:783–788

    CAS  Article  PubMed  Google Scholar 

  11. Stucki G, Daltroy L, Katz JN (1996) Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine 21:796–803

    CAS  Article  PubMed  Google Scholar 

  12. North American Spine Society Evidence-Based Clinical Guidelines Committee (2011) III. Definition and natural history of degenerative lumbar spinal stenosis. In: Diagnosis and treatment of degenerative lumbar spinal stenosis. http://www.spine.org/Documents/ResearchClinicalCare/Guidelines/LumbarStenosis.pdf. Accessed 03 Jan 2017

  13. Bajwa NS, Toy JO, Ahn NU (2012) Is lumbar stenosis associated with thoracic stenosis? A study of 1072 human cadaveric specimens. Spine J 12:1142–1146

    Article  PubMed  Google Scholar 

  14. van Eck CF, Spina NT III, Lee JY (2017) A novel MRI classification system for congenital functional lumbar spinal stenosis predicts the risk for tandem cervical spinal stenosis. Eur Spine J 26:368–373

    Article  PubMed  Google Scholar 

  15. Nagata K, Yoshimura N, Hashizume H, Muraki S, Ishimoto Y, Yamada H, Takiguchi N, Nakagawa Y, Minamide A, Oka H, Kawaguchi H, Nakamura K, Akune T, Yoshida M (2014) The prevalence of cervical myelopathy among subjects with narrow cervical spinal canal in a population-based magnetic resonance imaging study: The Wakayama Spine Study. Spine J 14:2811–2817

    Article  PubMed  Google Scholar 

  16. Ghobrial GM, Oppenlander ME, Maulucci CM, Viereck M, Prasad S, Sharan AD, Harrop JS (2014) Management of asymptomatic cervical spinal stenosis in the setting of symptomatic tandem lumbar stenosis: a review. Clin Neurol Neurosurg 124:114–118

    Article  PubMed  Google Scholar 

  17. Ministry of Health, Labour and Welfare. The report of National Health and Nutrition Survey 2005 (in Japanese). http://www.mhlw.go.jp/bunya/kenkou/eiyou/dl/h20-houkoku-04.pdf. Accessed 03 Jan 2017

Download references

Acknowledgements

This study was supported by: Wakayama Medical Award for Young Researchers in 2014 to Keiji Nagata, H23-Choujyu-002 (Director, Toru Akune), H-25-Choujyu-007 (Director, Noriko Yoshimura), H25-Nanchitou (Men)-005 (Director, Sakae Tanaka), 201417014A (Director, Noriko Yoshimura), and H22-Choujyu-Wakate-007 (Director, Shigeyuki Muraki) from the Ministry of Health, Labour and Welfare; a Grant-in-Aid for Scientific Research (B26293139, B23390172 to Noriko Yoshimura, B2629333, C20591774 to Shigeyuki Muraki, C26462249 to Hiroshi Hashizume, C25462305 to Hiroshi Yamada); a Grant-in-Aid for Young Researchers (B25860448 to Yuyu Ishimoto, B26860419 to Ryohei Kagotani, B15K20013 to Hiroki Iwahashi); a Grant-in-Aid for Challenging Exploratory Research (15K15219 to Noriko Yoshimura, 26670307 to Shigeyuki Muraki, 24659666 to Hiroyuki Oka, 25670293 to Toru Akune) of JSPS KAKENHI grant; This study also was supported by grants from the Japan Osteoporosis Society (Noriko Yoshimura, Shigeyuki Muraki, Hiroyuki Oka, and Toru Akune), a grant from JA Kyosai Research Institute (Hiroyuki Oka), grants from Mitsui Sumitomo Insurance Welfare Foundation (Shigeyuki Muraki), and research aid from the Japanese Orthopaedic Association (JOA-Subsidized Science Project Research 2006-1 and 2010-2; Director, Hiroshi Kawaguchi). The study sponsors played no role in the study design, the collection, analysis, and interpretation of data, writing of the report, or the decision to submit the paper for publication. The corresponding author had full access to all the data and had the final decision to submit for publication. The authors wish to thank Dr. Takako Nojiri and Mr. Kazuhiro Hatanaka of the Gobo Public Health Centre; Dr. Naoki Hirabayashi of the Kawakami Clinic, Hidakagawa Town; Mrs. Tomoko Takijiri, Mrs. Kumiko Shinou, Mrs. Rie Takiguchi, Mrs. Kyoko Maeda, Ms. Ikuyo Ueyama, Mrs. Michiko Mori, Mrs. Hisayo Sugimoto, and other members of the public office in Hidakagawa Town; Dr. Shinji Matsuda of the Shingu Public Health Centre; and Mrs. Tamako Tsutsumi, Mrs. Kanami Maeda, Mr. Shoichi Shimoichi, Mrs. Megumi Takino, Mrs. Shuko Okada, Mrs. Kazuyo Setoh, Mrs. Chise Ryouno, Mrs. Miki Shimosaki, Mrs. Chika Yamaguchi, Mrs. Yuki Shimoji, and other members of the public office in Taiji Town for their assistance in locating and scheduling participants for examinations. We also thank Ms. Kyoko Yoshimura, Mrs. Toki Sakurai, and Mrs. Saeko Sahara for their assistance with data reduction and administration.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hiroshi Hashizume.

Ethics declarations

Conflict of interest

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nagata, K., Yoshimura, N., Hashizume, H. et al. The prevalence of tandem spinal stenosis and its characteristics in a population-based MRI study: The Wakayama Spine Study. Eur Spine J 26, 2529–2535 (2017). https://doi.org/10.1007/s00586-017-5072-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-017-5072-0

Keywords

  • Cervical cord compression
  • Lumbar spinal stenosis
  • Developmental canal stenosis
  • Canal-to-body ratio
  • Tandem spinal stenosis