Surgical outcomes for lumbar spinal canal stenosis with coexisting cervical stenosis (tandem spinal stenosis): a retrospective analysis of 565 cases

Long-term outcomes of spine surgery in dialysis patients, focusing on activities of daily living, life expectancy, and the risk factors for postoperative mortality

BACKGROUND

Because of the high incidence of major perioperative adverse events, spine surgery in dialysis patients should be recommended carefully after consideration of its risks and benefits. However, the benefits of spine surgery in dialysis patients remain unclear because of the lack of long-term outcomes. The purpose of this study is to elucidate the long-term outcomes of spine surgery in dialysis patients, focusing on activities of daily living (ADLs), life expectancy, and risk factors for postoperative mortality.

METHODS

Data for 65 dialysis patients who underwent spine surgery at our institution and were followed up for a mean duration of 6.2 years were retrospectively reviewed. ADLs, number of surgeries, and survival times were recorded. The postoperative survival rate was calculated using the Kaplan-Meier method, and risk factors for postoperative mortality were investigated using a generalized Wilcoxon test and multivariate Cox proportional-hazards model.

RESULTS

Compared with preoperative ADLs, ADLs significantly improved at discharge after surgery and at the final follow-up. However, 16 of the 65 patients (24.6%) underwent multiple surgeries, and 34 (52.3%) died during the follow-up period. Kaplan-Meier analysis revealed that the survival rate after spine surgery was 95.4% at 1 year, 86.2% at 3 years, 69.6% at 5 years, 59.7% at 7 years, and 28.7% at 10 years, and the overall median survival time was 99 months. Multivariate Cox regression analysis showed that a dialysis period of ≥10 years was a significant risk factor.

CONCLUSIONS

Spine surgery in dialysis patients improved and maintained ADLs in the long term and did not shorten life expectancy. However, dialysis patients undergoing spine surgery require multiple surgeries more frequently, and a dialysis period of ≥10 years is a significant risk factor for postoperative mortality.

Demographic and Clinical Characteristics of Patients With Cervical Spine Degeneration Reveal Frequent Cervicolumbar Tandem Spinal Stenosis in Mexico

BACKGROUND

Limited literature exists regarding the differences in demographics, causes, comorbidities, presentation, and structural changes associated with cervical spine degeneration in patients from distinct geographic regions. The authors aimed to evaluate the demographic and clinical characteristics of patients with cervical spine degeneration admitted to a single center in Mexico.

METHODS

This study enrolled patients with degenerative disease of the cervical spine. Clinical data were retrieved from medical records and retrospectively characterized.

RESULTS

A total of 50 patients with cervical spine degeneration were included in the analysis. Of these, 26% were men with a median age of 54 years. Hypertension, depression, anxiety, obesity, and alcohol consumption were presented in about a quarter of the participants. In addition, we observed hypertriglyceridemia and hypercholesterolemia in 72% and 46% of participants, respectively. The median duration of symptoms was 11 months, including radicular arm/neck pain (80%), tingling (80%), reduced muscle strength (48%), and gait disturbances (48%). Forty percent of patients had 2 cervical segments radiologically involved, mainly at C5-C6, with changes such as disc herniation (88%), foraminal stenosis with nerve root compression (67%), reduced spinal canal-to-vertebral body ratio (38%), and ligamentum flavum hypertrophy (24%). Also, 22% of patients showed degenerative cervical myelopathy. Strikingly, 48% of enrolled individuals showed cervicolumbar tandem spinal stenosis, mainly in L4-L5 and L5-S1, who were generally older, had a longer duration of symptoms, and had a higher comorbidity burden, including hyperglycemia, hypertension, and depression.

CONCLUSIONS

The demographic and clinical characteristics of degenerative cervical spine disease in Mexico differ with respect to other geographical regions by a younger age of diagnosis, a high frequency of cardiovascular, metabolic, and mental health comorbidities, and an increased prevalence of concomitant lumbar spinal stenosis.

CLINICAL RELEVANCE

Our findings reveal a considerably high burden of cervicolumbar tandem spinal stenosis as a distinctive feature of Mexican patients with cervical spine degeneration.

LEVEL OF EVIDENCE: 1

Meta-Analysis of Simultaneous versus Staged Decompression of Stenotic Regions in Patients with Tandem Spinal Stenosis

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.

Outcomes in surgical treatment for tandem spinal stenosis: systematic literature review

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.

Radiographic predictors for recurrence of lumbar symptoms after prioritized cervical surgery in patients with tandem spinal stenosis

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.

Patient-Reported Outcomes for Lumbar Fusion in Patients with Previously Treated Cervical Myelopathy

BACKGROUND

Patients with a history of surgically treated cervical myelopathy and lumbar pathology requiring fusion present complex challenges, and literature describing patient-reported outcomes in this cohort beyond patients with tandem spinal stenosis is sparse. This has led to unclear guidelines in the literature. We present the first dataset comparing patient-reported outcomes for lumbar fusion in patients with isolated lumbar pathology versus patients with a history of surgically treated cervical myelopathy.

METHODS

In this retrospective cohort study of a prospectively collected lumbar fusion database, variables of interest included demographics, comorbidities, type and levels of fusion, Oswestry Disability Index (ODI), and minimal clinically important difference.

RESULTS

Of 325 patients identified, 309 met inclusion criteria. Of these, 29 patients had previous cervical surgery to address cervical myelopathy. Median time between cervical and lumbar surgery was 4.0 years (range, 0.3-19.7). There was no statistical difference in preoperative ODI score (24.8 vs. 25.6, P = 0.687), 6-month postoperative ODI score (17.3 vs. 18.7, P = 0.459), change in ODI score (7.5 vs. 6.9, P = 0.673), or minimal clinically important difference for ODI score (62.1% vs. 58.6%, P = 0.710) in patients who had undergone cervical surgery versus patients who had not.

CONCLUSIONS

Patients with a history of previously treated cervical myelopathy have a similar rate of clinically relevant improvement after lumbar fusion compared with patients without such history. As such, these patients appear to benefit from lumbar fusion surgery to the same degree as patients without a history of surgically treated cervical myelopathy.

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

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.

Extent and characteristic of relationships in canal dimension and canal body ratio between cervical and lumbar spine

A known prevalence of concurrent cervical and lumbar spinal stenosis was shown to be 5–25%, but there is a lack of evidence regarding direct relationships in canal dimension and canal-body ratio between cervical and lumbar spine. Total 247 patients (mean age: 61 years, male: 135) with cervical and lumbar computed tomography scans were retrospectively reviewed. Midsagittal vertebral body and canal diameters in reconstructed images were measured at all cervical and lumbar vertebrae, and canal-body ratios were calculated. The canal diameter and ratio were also compared according to the gender and age, and correlation analysis was performed for each value. There were significant correlations between cervical (C3–C7) and lumbar (L1–L5) canal dimension (p < 0.001). C5 canal diameter was most significantly correlated with L4 canal diameter (r = 0.435, p < 0.001). Cervical canal-body ratios (C3–C7) were also correlated with those of lumbar spine (L1–L5) (p < 0.001). The canal-body ratio of C3 was most highly correlated with L3 (r = 0.477, p < 0.001). Meanwhile, mean canal-body ratios of C3 and L3 were significantly smaller in male patients than female (p = 0.038 and p < 0.001) and patient’s age was inversely correlated with C5 canal diameter (r = − 0.223, p < 0.001) and C3 canal-body ratio (r = − 0.224, p < 0.001). Spinal canal dimension and canal-body ratio have moderate degrees of correlations between cervical and lumbar spine and the elderly male patients show the tendency of small canal diameter and canal-body ratio. This relationship of cervical and lumbar spine can be an important evidence to explain to the patients.

Diagnosis experience and literature review of patients with cervical, thoracic and lumbar multi-segment spinal stenosis: A case report

BACKGROUND

The incidence of cervical, thoracic and lumbar spinal canal stenosis is low. It is difficult to identify the main focus and responsible segment, and it is also difficult to select the sequence of staging surgery. We report a patient with triple stenosis.

CASE PRESENTATION

In this paper, we introduced a 61-year-old female patient with cervical, thoracic and lumbar spinal canal stenosis who had previously undergone "lumbar discectomy" in the outer hospital. The postoperative effect was not good and the symptoms were poor. The diagnosis was "cervical spinal stenosis and lumbar spine surgery." The staged spinal canal decompression operation and Duhuo Jisheng Decoction (DHJSD) treatment were conducted in our hospital. After 3 months of follow-up, the functional and imaging results were satisfactory.

CONCLUSION

We should pay enough attention to the patients with spinal degenerative diseases who need surgery, and must pursue the unity of medical history, signs and images. In case of difficult patients, more comprehensive examination is required, and the main focus and responsible segment are determined through comprehensive analysis. The more important diseases that may exist cannot be covered up by focal lesion manifestations, so as to avoid unnecessary surgical trauma for patients. In addition, surgery combined with Chinese herbal medicine DHJSD therapy may be an effective treatment for this kind of disease.

Subclinical gait disturbance and postoperative gait improvement in patients with degenerative cervical myelopathy

This study aimed to evaluate the subclinical gait abnormalities and the postoperative gait improvements in patients with degenerative cervical myelopathy using three-dimensional gait analysis. We reviewed the gait analysis of 62 patients who underwent surgical treatment for degenerative cervical myelopathy. The asymptomatic gait group included 30 patients and the gait disturbance group included 32 patients who can walk on their own slowly or need assistive device on stairs. The step width (17.2 cm vs. 15.9 cm, P = 0.003), stride length (105.2 cm vs. 109.1 cm, P = 0.015), and double-limb support duration (13.4% vs. 11.7%, P = 0.027) improved only in the asymptomatic gait group. Preoperatively, the asymptomatic gait group exhibited better maximum knee flexion angle (60.5° vs. 54.8°, P = 0.001) and ankle plantarflexion angle at push-off (− 12.2° vs. − 6.5°, P = 0.001) compared to the gait disturbance group. Postoperatively, maximum knee flexion angle (62.3° vs. 58.2°, P = 0.004) and ankle plantarflexion angle at push-off (− 12.8° vs. − 8.3°, P = 0.002) were still better in the asymptomatic gait group, although both parameters improved in the gait disturbance group (P = 0.005, 0.039, respectively). Kinematic parameters could improve in patients with gait disturbance. However, temporospatial parameters improvement may be expected when the operative treatment is performed before apparent gait disturbance.

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

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.

Surgical outcomes of the thoracic ossification of ligamentum flavum: a retrospective analysis of 61 cases

Background

Thoracic ossification of ligamentum flavum (T-OLF), as one of the causes of thoracic myelopathy, is often combined with other spinal disorders. Concurrent lumbar spinal canal stenosis (LCS) is often obscured by symptoms due to T-OLF, leading to difficulty in identifying the origin of these neurological findings. It is common to be misdiagnosed or delayed diagnosis due to the complicated nature. We evaluated the prevalence, distribution, and clinical characteristics of OLF, especially in patients with LCS.

Methods

The authors performed a retrospective analysis of the outcomes of 61 patients who underwent thoracic surgeries performed for symptomatic T-OLF. In all the patients, whole spine lesions were evaluated preoperatively. We examined the factors related to poor outcomes (the recovery rate of the Japanese Orthopedic Association score for thoracic myelopathy is less than 40%) following OLF surgeries. We compared the clinical outcomes according to whether there was concurrent LCS, and determined the optimal surgical approach.

Results

The occurrence of T-OLF increased with age. Forty-six cases (75.4%) were considered to be tandem T-OLF and LCS (LCS group). An advanced age, and concurrent LCS were associated with a poor outcome after the surgery. The LCS group significantly included a greater number of elderly, and more light-weighted patients with Modic change in thoracic spine and a greater sagittal vertical axis, resulting in the lower neurological recovery. Additional lumbar surgery (13cases) effectively improved both the T-JOA and L-JOA scores (from 6.5 ± 2.0 points to 8.0 ± 1.8 points, p = 0.0406, and from 14.5 ± 4.7 points to 20.7 ± 2.6 points, p = 0.001, respectively) in OLF patients with LCS.

Conclusions

T-OLF was highly associated with other spinal disorders. Poor outcomes in T-OLF surgery could be associated with age and concurrent LCS, and an additional surgery for another lumbar lesion significantly improved neurological findings in T-OLF patients.

Evaluation and Treatment of Tandem Spinal Stenosis

Tandem spinal stenosis (TSS) refers to simultaneous narrowing of noncontiguous regions of the spinal canal, typically the cervical and lumbar region. Symptomatic TSS may be present in more than 10% of patients presenting with spinal symptoms secondary to stenosis in any one region. Clinical presentation may present challenges because of a mixture of upper and lower motor neuron lesions that can confuse and mislead the clinician. Stenosis at another level may only be detected late, when there is failure to improve after treatment, and, if not detected, can result in either poor treatment outcomes or catastrophic complications. There is no uniform agreement in the management of TSS, and the reported surgical strategies include both simultaneous and staged approaches with each having positive and negative features. This article aims to provide the reader with details on the prevalence, evaluation, and guidance in treatment strategy for TSS.

[Research progress in minimally invasive treatment of cervical nerve root canal stenosis under total endoscope]

Objective

To review the research progress of total endoscopic minimally invasive technique in treating cervical nerve root canal stenosis (CNRCS).

Methods

The related literature at home and abroad was extensively reviewed. The research history, current situation, research progress, advantages and disadvantages of minimally invasive treatment of CNRCS under total endoscope were summarized.

Results

In recent years, with the continuous development of minimally invasive technique of total endoscope in spine surgery, the surgical treatment methods are also constantly innovated. Compared with the traditional open surgery, minimally invasive treatment of CNRCS under total endoscope can obtain better effectiveness, keep the stability of the cervical segment to the maximum extent, reduce the impact on the activity of the cervical spine and the occurrence of related surgical complications, which is an effective minimally invasive technology.

Conclusion

The minimally invasive treatment of CNRCS under total endoscope has achieved some results, which is expected to be one of the indispensable means to treat CNRCS, but it still needs to be improved.

Ten-year Longitudinal Follow-up MRI Study of Age-related Changes in Thoracic Intervertebral Discs in Asymptomatic Subjects

STUDY DESIGN

Prospective longitudinal study.

OBJECTIVE

The aim of this study was to evaluate long-term degenerative changes in intervertebral discs in the thoracic spine in healthy asymptomatic subjects.

SUMMARY OF BACKGROUND DATA

Longitudinal magnetic resonance imaging (MRI) studies of intervertebral disc degeneration have been reported for the cervical and lumbar but not the thoracic spine.

METHODS

In this longitudinal study (average follow-up 10.0 ± 0.6 years), we assessed degenerative changes in the thoracic spine of 103 volunteers (58 men) of 223 healthy volunteers in the initial MRI study of the thoracic spine (follow-up rate 46.2%). The mean age at the initial study was 45.0 ± 11.5 years (24-77 years). Initial and follow-up thoracic-spine MRIs were graded for the following 4 factors of degenerative changes: decrease in signal intensity of intervertebral disc (DSI), posterior disc protrusion (PDP), anterior compression of dura and spinal cord (AC), and disc-space narrowing (DSN) from T1-2 to T12-L1. We assessed associations between changes in MRI grade and demographical factors such as age, sex, body mass index, smoking habits, sports activities, and disc degeneration in the cervical spine.

RESULTS

MRIs revealed that 63.1% of the subjects had degenerative changes in the thoracic intervertebral discs that had progressed at least one grade during the follow-up period. DSI progressed in 44.7% of subjects, PDP in 21.4%, and AC in 18.4% during the 10-year period. No DSN progression was seen. DSI was frequently observed in the upper thoracic spine (T1-2 to T4-5). Disc degeneration was relatively scarce in the lower thoracic spine (T9-10 to T12-L1). PDP was frequently observed in the middle thoracic spine (T5-6 toT8-9). We found significant associations between DSI and cervical-spine degeneration (P = .004) and between AC and smoking (P = .04).

CONCLUSION

Progressive thoracic disc degeneration, observed in 63.1% of subjects; was significantly associated with smoking and with cervical-spine degeneration.

LEVEL OF EVIDENCE

2.

Quality of life changes after lumbar decompression in patients with tandem spinal stenosis

OBJECTIVE

Tandem spinal stenosis (TSS) is a degenerative spinal condition characterized by spinal canal narrowing at 2 or more distinct spinal levels. It is an aging-related condition that is likely to increase as the population ages, but which remains poorly described in the literature. Here we sought to determine the impact of primary lumbar decompression on quality-of-life (QOL) outcomes in patients with symptomatic TSS.

PATIENTS AND METHODS

We retrospectively reviewed 803 patients with clinical and radiographic evidence of TSS treated between 2008 and 2014 with a minimum 2-year follow-up. The records of patients with clinical and radiographic evidence of concurrent cervical and lumbar stenosis were reviewed. Prospectively gathered QOL data, including the Pain Disability Questionnaire (PDQ), Patient Health Questionnaire-9 (PHQ-9), EuroQOL-5 Dimensions (EQ-5D), and Visual Analogue Scale (VAS) for low back pain, were assessed at the 6-month, 1-year, and 2-year follow-ups.

RESULTS

Of 803 identified patients (mean age 66.2 years; 46.9% male), 19.6% underwent lumbar decompression only, 14.1% underwent cervical + lumbar decompression, and 66.4% underwent conservative management only. Baseline VAS scores were similar across all groups, but patients undergoing conservative management had better baseline QOL scores on all other measures. Both surgical cohorts experienced significant improvements in the VAS, PDQ, and EQ-5D at all time points; patients in the cervical + lumbar cohort also had significant improvement in the PHQ-9. Conservatively managed patients showed no significant improvement in QOL scores at any follow-up interval.

CONCLUSION

Lumbar decompression with or without cervical decompression improves low back pain and QOL outcomes in patients with TSS. The decision to prioritize lumbar decompression is therefore unlikely to adversely affect long-term quality-of-life improvements.

Is cervical instability the cause of lumbar canal stenosis?

Aim:

On the basis of an experience with 12 cases, the validity and rationale of cervical spinal stabilization for cases having both cervical and lumbar spinal canal stenosis is analyzed.

Materials and Methods:

From March 2017 to May 2018, 12 patients presented with a major symptom of neurogenic claudication pain generally related to lumbar canal stenosis in addition to other symptoms related to cervical myelopathy. The average age was 57 years. All patients were clinically and radiologically diagnosed to have both cervical and lumbar spinal canal stenosis. Based on the concept that degenerative spinal spondylotic myelopathy is an outcome of spinal instability, all patients underwent cervical spinal stabilization. No decompression by bone resection was done. The lumbar spine was not surgically treated. Visual analog scale, the Japanese Orthopaedic Association, and Oswestry Disability Index were used to monitor patients before and after surgery.

Results:

There was dramatic relief from symptoms related both to cervical and to lumbar canal stenosis in the postoperative period. During the average period of follow-up of 12 months, none of the patients have experienced recurrence of lumbar pain or needed any surgery.

Conclusion:

The report highlights the possibility of recovery in lumbar canal stenosis related symptoms following cervical spinal stabilization surgery for associated cervical spinal stenosis. We conclude that in select cases, cervical spinal instability may be the cause of clinical and radiological observations in cases having lumbar canal stenosis.