Skip to main content

Advertisement

SpringerLink
Log in

Symptomatic tandem spinal stenosis: a clinical, diagnostic, and surgical challenge

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

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

    Article  CAS  Google Scholar 

  2. 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

    Article  CAS  Google Scholar 

  3. 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

    Article  Google Scholar 

  4. 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):513–521

    Article  Google Scholar 

  5. 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):378–384

    Article  CAS  Google Scholar 

  6. 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:1388–1391

    Article  CAS  Google Scholar 

  7. Boccanera L, Laus M (1987) Cauda equina syndrome following lumbar spinal stenosis surgery. Spine (Phila Pa 1976) 12:712–715

    Article  CAS  Google Scholar 

  8. 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):187–190

    Article  Google Scholar 

  9. 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):1904–1911

    Article  Google Scholar 

  10. 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):628–634

    Article  CAS  Google Scholar 

  11. 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):409–413

    Article  Google Scholar 

  12. 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 107:115–123

    Article  Google Scholar 

  13. 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):61–68

    Article  Google Scholar 

  14. Hsieh CH, Huang TJ, Hsu RW (1998) Tandem spinal stenosis: clinical diagnosis and surgical treatment. Changgeng Yi Xue Za Zhi 21(4):429–435

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurosurgical Unit, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland

    Gianpaolo Jannelli, Nalla Silva Baticam, Karima Tizi & Enrico Tessitore

  2. Neurological Unit, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland

    Andre Truffert & Agustina Maria Lascano

Authors
  1. Gianpaolo Jannelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nalla Silva Baticam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karima Tizi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andre Truffert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Agustina Maria Lascano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Enrico Tessitore
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gianpaolo Jannelli.

Ethics declarations

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

Informed consent was obtained.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jannelli, G., Baticam, N.S., Tizi, K. et al. Symptomatic tandem spinal stenosis: a clinical, diagnostic, and surgical challenge. Neurosurg Rev 43, 1289–1295 (2020). https://doi.org/10.1007/s10143-019-01154-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-019-01154-9

Keywords

Search

Navigation