Primary cervical decompression surgery may improve lumbar symptoms in patients with tandem spinal stenosis

Abstract

Purpose

Tandem spinal stenosis (TSS) refers to coexisting lumbar and cervical canal stenosis. Evidence regarding whether cervical decompression improves lumbar symptoms in TSS is insufficient. Therefore, we determined the effectiveness of cervical decompression surgery for patients with lumbar spinal stenosis (LSS) and cervical spinal stenosis.

Methods

The records of 64 patients with TSS experiencing lumbar symptoms who underwent cervical decompression surgery between April 2013 and July 2017 at a single institution were retrospectively reviewed. We categorized patients into the Non-improved (n = 20), Relapsed (n = 30), and Maintained-improvement (n = 14) groups according to the presence or absence of improvement and relapse in lower limb symptoms in TSS following cervical decompression surgeries.

Results

Of 64 patients, 44 (69%) showed improved lower limb or low back symptoms, with 14 (22%) patients maintaining improvement. The preoperative cervical myelopathy-Japanese Orthopedic Association score and the preoperative number of steps determined using the 10-s step test were significantly lower in the Non-improved group than in the Maintained-improvement group. Receiver operating characteristic curve of preoperative 10-s step test results revealed 12 steps as a predictor for maintained improvement.

Conclusion

The improvement of LSS symptoms following cervical decompression surgeries may be associated with the severity of cervical myelopathy as determined in clinical findings rather than in imaging findings. Patients with TSS having a 10-s step test result of < 12 steps were more likely to experience a relapse of lower limb symptoms following cervical decompression surgeries.

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References

  1. 1.

    Teng P, Papatheodorou C (1964) Combined cervical and lumbar spondylosis. Arch Neurol 10:298–307

    CAS  Article  Google Scholar 

  2. 2.

    Overley SC, Kim JS, Gogel BA, Merrill RK, Hecht AC (2017) Tandem spinal stenosis: a systematic review. JBJS Rev 5:e2. https://doi.org/10.2106/JBJS.RVW.17.00007

    Article  PubMed  Google Scholar 

  3. 3.

    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. https://doi.org/10.3171/jns.1987.66.6.0842

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Lee MJ, Garcia R, Cassinelli EH, Furey C, Riew KD (2008) Tandem stenosis: a cadaveric study in osseous morphology. Spine J 8:1003–1006. https://doi.org/10.1016/j.spinee.2007.12.005

    Article  PubMed  Google Scholar 

  5. 5.

    Nagata K, Yoshimura N, Hashizume H, Ishimoto Y, Muraki S, Yamada H, Oka H, Kawaguchi H, Akune T, Tanaka S, Nakamura K, Yoshida M (2017) 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. https://doi.org/10.1007/s00586-017-5072-0

    Article  PubMed  Google Scholar 

  6. 6.

    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. https://doi.org/10.1016/j.clineuro.2014.06.012

    Article  PubMed  Google Scholar 

  7. 7.

    Felbaum DR, Fayed I, Stewart JJ, Sandhu FA (2016) Relief of lumbar symptoms after cervical decompression in patients with tandem spinal stenosis presenting with primarily lumbar pain. Cureus 8:e940. https://doi.org/10.7759/cureus.940

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Kim CH, Chung CK, Lee U, Choi Y, Park SB, Jung JM, Hwang SH, Yang SH (2018) Postoperative changes in moderate to severe nonspecific low back pain after cervical myelopathy surgery. World Neurosurg 116:e429–e435. https://doi.org/10.1016/j.wneu.2018.04.224

    Article  PubMed  Google Scholar 

  9. 9.

    Kawakita E, Kasai Y, Uchida A (2009) Low back pain and cervical spondylotic myelopathy. J Orthop Surg (Hong Kong) 17:187–189. https://doi.org/10.1177/230949900901700213

    Article  Google Scholar 

  10. 10.

    Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K (1981) Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine 6:354–364. https://doi.org/10.1097/00007632-198107000-00005

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Ono K, Ebara S, Fuji T, Yonenobu K, Fujiwara K, Yamashita K (1987) Myelopathy hand. New clinical signs of cervical cord damage. J Bone Jt Surg Br 69:215–219

    CAS  Article  Google Scholar 

  12. 12.

    Yukawa Y, Kato F, Ito K, Horie Y, Nakashima H, Masaaki M, Ito ZY, Wakao N (2009) “Ten second step test” as a new quantifiable parameter of cervical myelopathy. Spine 34:82–86. https://doi.org/10.1097/BRS.0b013e31818e2b19

    Article  PubMed  Google Scholar 

  13. 13.

    Nagata K, Kiyonaga K, Ohashi T, Sagara M, Miyazaki S, Inoue A (1990) Clinical value of magnetic resonance imaging for cervical myelopathy. Spine (Phila Pa 1976) 15:1088–1096. https://doi.org/10.1097/00007632-199011010-00002

    CAS  Article  Google Scholar 

  14. 14.

    Lurie JD, Tosteson AN, Tosteson TD, Carragee E, Carrino JA, Kaiser J, Sequeiros RT, Lecomte AR, Grove MR, Blood EA, Pearson LH, Weinstein JN, Herzog R (2008) Reliability of readings of magnetic resonance imaging features of lumbar spinal stenosis. Spine (Phila Pa 1976) 33:1605–1610. https://doi.org/10.1097/brs.0b013e3181791af3

    Article  Google Scholar 

  15. 15.

    Krishnan A, Dave BR, Kambar AK, Ram H (2014) Coexisting lumbar and cervical stenosis (tandem spinal stenosis): an infrequent presentation. Retrospective analysis of single-stage surgery (53 cases). Eur Spine J 23:64–73. https://doi.org/10.1007/s00586-013-2868-4

    Article  PubMed  Google Scholar 

  16. 16.

    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 24:409–413. https://doi.org/10.1097/BSD.0b013e318201bf94

    Article  PubMed  Google Scholar 

  17. 17.

    Yamada T, Yoshii T, Yamamoto N, Hirai T, Inose H, Okawa A (2018) Surgical outcomes for lumbar spinal canal stenosis with coexisting cervical stenosis (tandem spinal stenosis): a retrospective analysis of 565 cases. J Orthop Surg Res 13:60. https://doi.org/10.1186/s13018-018-0765-6

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    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 28:61–68. https://doi.org/10.1007/s00586-018-5795-6

    Article  PubMed  Google Scholar 

  19. 19.

    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 Jt Surg Br 94:378–384. https://doi.org/10.1302/0301-620X.94B3.27867

    CAS  Article  Google Scholar 

  20. 20.

    Li H, Chen Z, Li X, Liu T, Shen B, Huang Y, Wu D (2017) Prioritized cervical or lumbar surgery for coexisting cervical and lumbar stenosis: prognostic analysis of 222 case. Int J Surg 44:344–349. https://doi.org/10.1016/j.ijsu.2017.07.027

    Article  PubMed  Google Scholar 

  21. 21.

    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 17:24–29. https://doi.org/10.3171/2012.3.SPINE111080

    Article  PubMed  Google Scholar 

  22. 22.

    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 (Phila Pa 1976) 35:2057–2063. https://doi.org/10.1097/brs.0b013e3181f4588a

    Article  Google Scholar 

  23. 23.

    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. https://doi.org/10.1007/s00402-012-1465-z

    Article  PubMed  Google Scholar 

  24. 24.

    Kawaguchi Y, Oya T, Abe Y, Kanamori M, Ishihara H, Yasuda T, Nogami S, Hori T, Kimura T (2005) Spinal stenosis due to ossified lumbar lesions. J Neurosurg Spine 3:262–270. https://doi.org/10.3171/spi.2005.3.4.0262

    Article  PubMed  Google Scholar 

  25. 25.

    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 22:593–601. https://doi.org/10.1097/BSD.0b013e3181929cbd

    Article  PubMed  Google Scholar 

  26. 26.

    Aiwale A, Patel P, Paspala S, Murthy T (2019) Simultaneous cervical and lumbar spine surgery: retrospective analysis of 45 cases. Indian J Neurosurg 08:047–052. https://doi.org/10.1055/s-0039-1677962

    Article  Google Scholar 

  27. 27.

    Chen SH, Hui YL, Yu CM, Niu CC, Lui PW (2005) Paraplegia by acute cervical disc protrusion after lumbar spine surgery. Chang Gung Med J 28:254–257

    PubMed  Google Scholar 

  28. 28.

    Deem S, Shapiro HM, Marshall LF (1991) Quadriplegia in a patient with cervical spondylosis after thoracolumbar surgery in the prone position. Anesthesiology 75:527–528

    CAS  Article  Google Scholar 

  29. 29.

    Johnsson KE, Rosen I, Uden A (1992) The natural course of lumbar spinal stenosis. Clin Orthop Relat Res 279:82–86

    Google Scholar 

  30. 30.

    Karadimas SK, Erwin WM, Ely CG, Dettori JR, Fehlings MG (2013) Pathophysiology and natural history of cervical spondylotic myelopathy. Spine (Phila Pa 1976) 38:S21–S36. https://doi.org/10.1097/brs.0b013e3182a7f2c3

    Article  Google Scholar 

  31. 31.

    Bednarik J, Kadanka Z, Dusek L, Novotny O, Surelova D, Urbanek I, Prokes B (2004) Presymptomatic spondylotic cervical cord compression. Spine (Phila Pa 1976) 29:2260–2269

    Article  Google Scholar 

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Funding

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.

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Correspondence to Shiro Imagama.

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The Institutional Review Board in our institution approved this study, and written informed consent was obtained from each patient before study participation or surgery.

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Inoue, T., Ando, K., Kobayashi, K. et al. Primary cervical decompression surgery may improve lumbar symptoms in patients with tandem spinal stenosis. Eur Spine J (2021). https://doi.org/10.1007/s00586-020-06693-0

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Keywords

  • Tandem spinal stenosis
  • Cervical decompression surgery
  • Lower limb symptom
  • 10-s step test