Surgeries for Patients with Tandem Spinal Stenosis in Cervical and Thoracic Spine: Combined or Staged Surgeries?

BACKGROUND: Cervical and thoracic tandem spinal stenosis (ct-TSS) is a rare yet challenging degenerative disease. When the diagnosis is made, surgical decompression is indicated for both lesions. However, literature about the surgical approaches and prognosis of this disease is lacking.

METHODS: From March 2005 to April 2013, 30 patients with ct-TSS and a mean age of 49.8 years were recruited. We outlined 2 types of ct-TSS lesions-adjacent and skip lesions. The surgical approach for ct-TSS with adjacent lesions was combined cervical and thoracic decompression via a single posterior incision; the approach for skip lesions was 2-stage sequential cervical and thoracic decompressions. Neurologic status was evaluated with the Japanese Orthopaedic Association scale for cervical myelopathy.

RESULTS: Seventeen patients underwent 1-stage surgery, and 13 patients underwent the 2-stage procedure. After surgery, 27 patients (90%) experienced improvement. Main complications included transient neurologic deterioration in 7 patients, dural tears in 14 patients, and new radiculopathy in 4 patients. Combined and staged groups were comparable in terms of total length of decompression, occurrence of perioperative complications, and recovery rate (P > 0.05). The average Japanese Orthopaedic Association score increased significantly from 9.8 ± 1.9 to 13.7 ± 3.0 (P < 0.05), and the average recovery rate was 54.4%.

CONCLUSIONS: The types of stenotic lesions should be considered when planning surgery for patients with ct-TSS. One-stage decompression is suitable for patients with adjacent stenotic lesions; staged procedures should be considered for other patients.