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Hayashi H, Hashikata H, Sawada M, Toda H. Low back pain improvement after cervical laminoplasty in patients without tandem lumbar stenosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4437-4443. [PMID: 37736774 DOI: 10.1007/s00586-023-07951-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/09/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE This study aimed to demonstrate the impact of lumbar spinal stenosis (LSS) on LBP after cervical laminoplasty for cervical spinal stenosis by analyzing the clinical characteristics and surgical outcomes. METHODS This retrospective cohort study analyzed 56 consecutive patients with cervical spinal stenosis who underwent cervical laminoplasty. Data on age, sex, Japanese Orthopaedic Association (JOA) scores, JOA Back Pain Evaluation Questionnaire (BPEQ), and visual analog scale (VAS) were collected. The patients with VAS for LBP ≥ 30 or more were included and divided into two groups: without LSS [LSS (-)]or with LSS [LSS (+)]. Preoperative clinical characteristics and postoperative changes were compared between the groups. RESULTS Preoperative VAS for LBP were 50.7 ± 16.2 mm and 59.8 ± 19.5 mm in the LSS (+) and LSS (-), respectively (p = 0.09). Patients in the LSS (-) were younger (57.6 ± 11.2 vs. 70.7 ± 8.6, p < 0.001) and showed significantly milder preoperative lumbar symptoms in terms of JOA and BPEQ. Patients in the LSS (-) group showed more postoperative changes in low back pain (18.3 ± 26.4 vs. - 8.3 ± 37.6, p = 0.005) and lumbar function (10.8 ± 25.7 vs. - 2.0 ± 22.5, p = 0.04) at BPEQ, and higher recovery in terms of VAS of LBP (23.0 ± 23.8 mm vs. 5.3 ± 25.9 mm, p = 0.008) and buttocks and low limbs (12.5 ± 35.0 mm vs. - 4.3 ± 24.4 mm, p = 0.029). Nine patients in the LSS (+) group underwent lumbar surgery at 12.8 ± 8.5 months after cervical laminoplasty. CONCLUSION LBP improved after cervical laminoplasty in patients without lumbar stenosis.
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Affiliation(s)
- Hideki Hayashi
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan.
| | - Hirokuni Hashikata
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Masahiro Sawada
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Hiroki Toda
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
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Lu C, Qiu H, Huang X, Yang X, Liu D, Zhang S, Zhang Y. Meta-Analysis of Simultaneous versus Staged Decompression of Stenotic Regions in Patients with Tandem Spinal Stenosis. World Neurosurg 2023; 170:e441-e454. [PMID: 36396060 DOI: 10.1016/j.wneu.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tandem spinal stenosis (TSS) refers to simultaneous spinal canal stenosis of noncontiguous regions. There is no consensus in the surgical strategies for patients with symptomatic TSS because of the confusing clinical manifestations. This meta-analysis aimed to compare the outcomes of 1-stage and 2-stage decompression of all stenotic regions (cervical and lumbar/thoracic segments) in patients with TSS. METHODS A systematic review was conducted, and a comprehensive literature search with the Japanese Orthopedic Association score, was carried out using MEDLINE, Web of Science, and PubMed databases from inception to September 13, 2022. Observational studies reporting the outcomes after 1-stage or 2-stage decompression of all symptomatic regions were included. Possible heterogeneity among studies was assessed by the Higgins I2 test, and heterogeneity was statistically investigated using the Q statistic. RESULTS Thirteen retrospective observational studies were included in this meta-analysis. Meta-analysis showed that there was no significant difference in the Japanese Orthopedic Association score improvement in patients with TSS involving either the cervical-thoracic or cervical-lumbar segments. Regarding the surgical parameters and complications, 1-stage decompression showed comparable operation time, blood loss, and major complications to 2-stage decompression in patients with cervical and lumbar TSS. In patients with cervical and thoracic TSS, 1-stage decompression had significant advantages compared with 2-stage decompression in operation time, blood loss, and major complications. CONCLUSIONS For patients with cervical and lumbar TSS, 2-stage decompression showed slight advantages in clinical outcome without exposing patients to unnecessary surgical risks. For patients with cervical and thoracic TSS, 1-stage decompression showed comparable clinical outcome, although with better operative parameters and lower complication rate than in simultaneous decompression.
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Affiliation(s)
- Changbo Lu
- Department of Orthopaedic Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Haiyang Qiu
- Department of Orthopaedic Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Xinyi Huang
- Department of Orthopaedic Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Xiaojiang Yang
- Department of Orthopaedic Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Daming Liu
- Department of Orthopaedic Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Saili Zhang
- Department of Orthopaedic Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Yang Zhang
- Department of Orthopaedic Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China.
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Outcomes in surgical treatment for tandem spinal stenosis: systematic literature review. Spine J 2022; 22:1788-1800. [PMID: 35843535 DOI: 10.1016/j.spinee.2022.07.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/16/2022] [Accepted: 07/11/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Tandem spinal stenosis (TSS) refers to a narrowing of the spinal canal in distinct, noncontiguous regions. TSS most commonly occurs in the cervical and lumbar regions. Decompressive surgery is indicated for those with cervical myelopathy or persistent symptoms from lumbar stenosis despite conservative management. Surgical management typically involves staged procedures, with cervical decompression taking precedence in most cases, followed by lumbar decompression at a later time. However, several studies have shown favorable outcomes in simultaneous decompression. PURPOSE The aim of this study is to provide a literature review and compare surgical outcomes in patients undergoing staged vs simultaneous surgery for TSS. STUDY DESIGN/SETTING Systematic literature review. METHODS A systematic review using PRISMA guidelines to identify original research articles for tandem spinal stenosis. PubMed, Cochrane, Ovid, Scopus, and Web of Science were used for electronic literature search. Original articles from 2005 to 2021 with more than eight adult patients treated surgically for cervical and lumbar TSS in staged or simultaneous procedures were included. Articles including pediatric patients, primarily thoracic stenosis, stenosis secondary to neoplasm or infectious disease, minimally invasive surgery, and non-English language were excluded. Demographic, perioperative, complications, functional outcome, and neurologic outcome data including mJOA (modified Japanese Orthopaedic Association), Nurick grade (NG), and ODI (Oswestry disability index), were extracted and summarized. RESULTS A total of 667 articles were initially identified. After preliminary screening, 21 articles underwent full-text screening. Ten articles met our inclusion criteria. A total of 831 patients were included, 571 (68%) of them underwent staged procedures, and 260 (32%) underwent simultaneous procedures for TSS. Mean follow-ups ranged from 12 to 85 months. There was no difference in estimated blood loss (EBL) between staged and simultaneous groups (p=.639). Simultaneous surgeries had shorter surgical time than staged surgeries (p<.001). Mean changes in mJOA, NG, and ODI was comparable between staged and simultaneous groups. Complications were similar between the groups. There were more major complications reported in simultaneous operations, although this was not statistically significant (p=.301). CONCLUSION Staged and simultaneous surgery for TSS have comparable perioperative, functional, and neurologic outcomes, as well as complication rates. Careful selection of candidates for simultaneous surgery may reduce the length of stay and consolidate rehabilitation, thereby reducing hospital-associated costs.
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Wang Z, Ye W, Zhu Y, Tang P, Cai W. Radiographic predictors for recurrence of lumbar symptoms after prioritized cervical surgery in patients with tandem spinal stenosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2769-2776. [PMID: 35819541 DOI: 10.1007/s00586-022-07295-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/01/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The purpose of the current study was to explore radiographic predictors for recurrence of lumbar symptoms after prioritized cervical surgery in patients with tandem spinal stenosis (TSS). METHODS The current retrospective cohort study included 74 patients with TSS, who underwent prioritized cervical surgery. Based on presence or absence of improvement in lower limb symptoms, patients were grouped into improved and non-improved groups. Medical records and radiological parameters including age, sex, body mass index, cervical and lumbar parameters were analyzed. In improved group, patients were divided into relapsed and non-relapsed groups based on recurrence in lower limb symptoms. RESULTS Lumbar symptoms improved in 70.1% (n = 52) of patients. Comparison between the improved and non-improved group showed that there were no statistically significant differences in cervical parameters while comparisons between the relapsed and non-relapsed groups showed significant differences in redundant nerve roots (RNRs) (p = 0.029), narrow segment (p = 0.042) and lumbar stenosis index (LSI) (p = 0.003). In multivariate logistic regression analysis, LSI > 10 (p = 0.016) was independently associated with recurrence of lumbar symptoms. CONCLUSIONS Finding of the current study indicated that LSI > 10 was associated with recurrence of lumbar symptoms in TSS patients following cervical surgery.
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Affiliation(s)
- Zhuanghui Wang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Wu Ye
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Yufeng Zhu
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Pengyu Tang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Weihua Cai
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China.
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Bai Q, Wang Y, Zhai J, Wu J, Zhang Y, Zhao Y. Current understanding of tandem spinal stenosis: epidemiology, diagnosis, and surgical strategy. EFORT Open Rev 2022; 7:587-598. [PMID: 35924651 PMCID: PMC9458946 DOI: 10.1530/eor-22-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Tandem spinal stenosis (TSS) is defined as the concomitant occurrence of stenosis in at least two or more distinct regions (cervical, thoracic, or lumbar) of the spine and may present with a constellation of signs and symptoms. It has four subtypes, including cervico-lumbar, cervico-thoracic, thoraco-lumbar, and cervico-thoraco-lumbar TSS. The prevalence of TSS varies depending on the different subtypes and cohorts. The main aetiologies of TSS are spinal degenerative changes and heterotopic ossification, and patients with developmental spinal stenosis, ligament ossification, and spinal stenosis at any region are at an increased risk of developing TSS. The diagnosis of TSS is challenging. The clinical presentation of TSS could be complex, concealed, or severe, and these features may be confusing to clinicians, resulting in an incomplete or delayed diagnosis. Additionally, a consolidated diagnostic criterion for TSS is urgently required to improve consistency across studies and form a basis for establishing treatment guidelines. The optimal treatment option for TSS is still under debate; areas of controversies include choice of the decompression range, choice between simultaneous or staged surgical patterns, and the order of the surgeries. The present study reviews publications on TSS, consolidates current awareness on prevalence, aetiologies, potential risk factors, diagnostic dilemmas and criteria, and surgical strategies based on TSS subtypes. This is the first review to include thoracic spinal stenosis as a candidate disorder in TSS and aims at providing the readers with a comprehensive overview of TSS.
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Affiliation(s)
- Qiushi Bai
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuanyi Wang
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, China
| | - Jiliang Zhai
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jigong Wu
- Chinese People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Yan Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Zhao
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Mittal S, Ahuja K, Sudhakar PV, Ifthekar S, Yadav G, Sarkar B, Kandwal P. Simultaneous decompression of all stenotic regions versus decompression of only the most symptomatic region in patients with tandem spinal stenosis: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:561-574. [PMID: 34988710 DOI: 10.1007/s00586-021-07078-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/15/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Selection of anatomic region of spine for decompression in patients with symptomatic tandem spinal stenosis (TSS) remains a challenge due to the confusing clinical presentation as well as uncertain evidence. A systematic review and meta-analysis of observational studies were conducted to compare the outcomes between simultaneous decompression of all stenotic regions (cervical and lumbar, Group 1) and decompression of only the most symptomatic stenotic region (cervical/lumbar, Group 2) in patients with TSS. METHODS A systematic review was conducted, and a comprehensive literature search with well-established inclusion and exclusion criteria with JOA score as an outcome measure was done on PubMed, Google Scholar, and EMBASE database (till January 2021). Observational studies reporting outcomes after simultaneous decompression or only the most symptomatic region were included. NIH quality assessment tool was used to check the quality of each study, and treatment effects were calculated using Dersimonian and Laird random effects model. RESULTS Ten studies were included in the analysis out of which all were retrospective observational studies (Level 4 evidence) except one (Level 3 evidence). Overall proportional meta-analysis showed no significant difference in change in JOA scores, operative time, blood loss, total and major complications between Group 1 and Group 2. However, minor complications were significantly increased on performing decompression of both regions simultaneously (p = 0.04). On performing subgroup analysis comparing cervical surgery cohort with lumbar surgery cohort, no difference was found in change in JOA score and requirement of second-stage surgery. CONCLUSION Decompression of the most symptomatic region alone irrespective of its location has equal clinical outcomes with less complication rate than simultaneous decompression in patients with TSS.
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Affiliation(s)
| | | | - P V Sudhakar
- AIIMS Rishikesh, Rishikesh, Uttarakhand, 249203, India
| | - Syed Ifthekar
- AIIMS Rishikesh, Rishikesh, Uttarakhand, 249203, India
| | | | | | - Pankaj Kandwal
- Department of Orthopaedics, AIIMS Rishikesh, Rishikesh, Uttarakhand, 249203, India.
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Kumar V, Dhatt SS, Subramaniyam SR, Neradi D. Letter to the editor concerning "primary cervical decompression surgery may improve lumbar symptoms in patients with tandem spinal stenosis" by Inoue T, et al. (Eur Spine J; 2021 jan 6. doi: 10.1007/s00586-020-06,693-0). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1789. [PMID: 33847815 DOI: 10.1007/s00586-021-06801-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/17/2021] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Vishal Kumar
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | | | | | - Deepak Neradi
- Department of Orthopaedics, PGIMER, Chandigarh, India.
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