RESULTS OF STAGED SURGICAL TREATMENT OF PATIENTS WITH TANDEM STENOSIS OF THE CERVICAL AND LUMBOSACRAL SPINE

Objective. To conduct a retrospective analysis of staged surgery in patients with tandem stenosis of the cervical and lumbosacral spine, to identify causes of poor outcomes.

Material and Methods. The study included 190 patients with tandem stenosis of the cervical and lumbosacral spine. Out of them 72 had symptomatic cervical and asymptomatic lumbosacral tandem stenosis (Group 1), 67 - symptomatic lumbar and asymptomatic cervical tandem stenosis (Group 2), and 51 - compression with neurological manifestations in both spine departments (Group 3). Patient’s anthropometric data, initial clinical symptoms, and duration of disease were analyzed. The intraoperative characteristics of surgical interventions and features of the postoperative period, clinical parameters and the existence of complications were evaluated.

Results. Excellent and good postoperative outcomes were achieved in patients of Groups 1 and 2 with monosymptomatic tandem stenosis, in patients of Group 3 with symptomatic tandem stenosis, and in patients of all groups who underwent laminectomy and bilateral foraminotomy for bilateral symptomatic foraminal stenosis, and minimally invasive bilateral foraminotomy through unilateral approach in case of radiographic evidence of foraminal stenosis without symptoms.

Conclusion. Symptomatic tandem stenosis of the cervical and lumbosacral spine is a severe nosological entity requiring meticulous removal of pathological substrate primarily in the cervical spine. The early implementation of the second stage of surgery significantly reduces neurological symptoms, relieves pain and improves quality of life in patients. 

1. Бывальцев В.А., Шепелев В.В., Никифоров С.Б., Калинин А.А. Изолированные и сочетанные дегенеративные тандем-стенозы позвоночного канала шейного и поясничного отделов позвоночника: обзор литературы // Хирургия позвоночника. 2016. № 2. С. 52-61. DOI: http://dx.doi.org/10.14531/ss2016.2.52-61.

2. Бывальцев В.А., Сороковиков В.А., Калинин А.А., Егоров А.А., Белых Е.Г. Клинический пример хирургического лечения дегенеративного стеноза на двух уровнях в грудном отделе позвоночника // Хирургия. Журнал им. Н.И. Пирогова 2015. № 7. С. 93-96.

3. Калинин А.А., Бывальцев В.А. Взаимосвязь спондилометрических параметров с клиническим исходом хирургического лечения дегенеративного спондилолистеза при многоуровневых поражениях поясничных межпозвонковых дисков // Хирургия позвоночника. 2015. № 4. С. 56-62. DOI: http://dx.doi.org/10.14531/ss2015.4.56-62.

4. Крутько А.В. Сравнительный анализ результатов заднего межтелового спондилодеза (PLIF) и трансфораминального межтелового спондилодеза (TLIF) в сочетании с транспедикулярной фиксацией // Вестн. травматологии и ортопедии им. Н.Н. Приорова. 2012. № 1. С. 12-21.

5. Aydogan M, Ozturk C, Mirzanli C, Karatoprak O, Tezer M, Hamzaoglu A. Treatment approach in tandem (concurrent) cervical and lumbar spinal stenosis. Acta Orthop Belg. 2007;73:234-237.

6. Caron TH, Bell GR. Combined (tandem) lumbar and cervical stenosis. Semin Spine Surg. 2007;19:44-46. DOI: 10.1053/j.semss.2007.01.009.

7. Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg. 1958;15:602-617. DOI: 10.3171/jns.1987.66.6.0842.

8. Dagi TF, Tarkington MA, Leech JJ. Tandem lumbar and cervical spinal stenosis: natural history, prognostic indices, and results after surgical decompression. J Neurosurg. 1987;66:842-849. DOI: 10.3171/jns.1987.66.6.0842.

9. Eskander MS, Aubin ME, Drew JM, Eskander JP, Balsis SM, Eck J, Lapinsky AS, Connolly PJ. Is there a difference between simultaneous or staged decompression for combined cervical and lumbar stenosis? J Spinal Disord Tech. 2011;24:409-441. DOI: 10.1097/BSD.0b013e318201bf94.

10. Fager CA. Results of adequate posterior decompression in the relief of spondylitic cervical myelopathy. J Neurosurg. 1973;38:684-692.

11. Ghobrial GM, Oppenlander ME, Maulucci CM, Viereck M, Prasad S, Sharan AD, Harrop JS. Management of asymptomatic cervical spinal stenosis in the setting of symptomatic tandem lumbar stenosis: a review. Clin Neurol Neurosurg. 2014;124:114-118. DOI: 10.1016/j.clineuro.2014.06.012.

12. Hong CC, Liu KP. A rare case of multiregional spinal stenosis: clinical description, surgical complication, and management concept review. Global Spine J. 2015;5:49-54. DOI: 10.1055/s-0034-1378139.

13. Hsieh CH, Huang TJ, Hsu RW. Tandem spinal stenosis: clinical diagnosis and surgical treatment. Changgeng Yi Xue Za Zhi. 1998;21:429-435.

14. Kikuike K, Miyamoto K, Hosoe H, Shimizu K. 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. 2009;22:593-601. DOI: 10.1097/BSD.0b013e3181929cbd.

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

16. Kudo T, Sato Y, Kowatari K, Nitobe T, Hirota K. Postoperative transient tetraplegia in two patients caused by cervical spondylotic myelopathy. Anaesthesia. 2011;66:213-216. DOI: 10.1111/j.1365-2044.2010.06562.x.

17. LaBan MM, Green ML. Concurrent (tandem) cervical and lumbar spinal stenosis: a 10-year review of 54 hospitalized patients. Am J Phys Med Rehabil. 2004;83:187-190. DOI: 10.1097/01.PHM.0000113405.48879.45.

18. Lee MJ, Garcia R, Cassinelli EH, Furey C, Riew KD. Tandem stenosis: a cadaveric study in osseous morphology. Spine J. 2008;8:1003-1006. DOI: 10.1016/j.spinee.2007.12.005.

19. Mann KS, Khosla VK, Gulati DR. Cervical spondylitic myelopathy treated by single-stage multilevel anterior decompression. A prospective study. J Neurosurg. 1984;60:81-87. DOI: 10.3171/jns.1984.60.1.0081.

20. Matsumoto M, Okada E, Toyama Y, Fujiwara H, Momoshima S, Takahata T. Tandem age-related lumbar and cervical intervertebral disc changes in asymptomatic subjects. Eur. Spine J. 2013;22:708-713. DOI: 10.1007/s00586-012-2500-z.

21. Molinari RW, Flanigan R, Yaseen Z, Gruhn W, Molinari C. Tandem spinal stenosis (TSS): literature review and report of patients treated with simultaneous decompression. Curr Opin Orthop. 2012;23:356-363.

22. Naderi S, Mertol T. Simultaneous cervical and lumbar surgery for combined symptomatic cervical and lumbar spinal stenoses. J Spinal Disord Tech. 2002;15:229-231.

23. Schaffer JC, Raudenbush BL, Molinari C, Molinari RW. Symptomatic triple-region spinal stenosis treated with simultaneous surgery: case report and review of the literature. Global Spine J. 2015;5:513-521. DOI: 10.1055/s-0035-1566226.

24. Swanson BT. Tandem spinal stenosis: a case of stenotic cauda equina syndrome following cervical decompression and fusion for spondylotic cervical myelopathy. J Man Manip Ther. 2012;20:50-56. DOI: 10.1179/2042618611Y.0000000010.

25. Teresi LM, Lufkin RB, Reicher MA, Moffit BJ, Vinuela FV, Wilson GM, Bentson JR, Hanafee WN. Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology. 1987;164:83-88.

26. Zulkei A, Ramanathan R. Tandem spinal stenosis. Malays Orthop J. 2010;4:46-49.