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

BACKGROUND: Tandem spinal stenosis refers to simultaneous spinal canal stenosis of noncontiguous regions. There is no consensus in the surgical strategies for patients with symptomatic tandem spinal stenosis because of the confusing clinical manifestations. This meta-analysis aimed to compare the outcomes of one-stage and two-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 one-stage or two-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 JOA improvement in patients with TSS involving either the cervical-thoracic or cervical-lumbar segments. Regarding the surgical parameters and complications, one-stage decompression showed comparable operation time, blood loss and major complications to two-stage decompression in patients with cl-TSS. In patients with ct-TSS, one-stage decompression had significant advantages compared with two-stage decompression in operation time, blood loss and major complications.

CONCLUSIONS: For patients with cl-TSS, two-stage decompression exhibited slight advantages in clinical outcome without exposing patients to unnecessary surgical risks. For Patients with ct-TSS, one-stage decompression showed comparable clinical outcome whereas with better operative parameters and lower complication rate than simultaneous decompression.