Yamada Tsuyoshi, Yoshii Toshitaka, Yamamoto Naoki, Hirai Takashi, Inose Hiroyuki, Okawa Atsushi
Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
J Orthop Surg Res. 2018 Mar 20;13(1):60. doi: 10.1186/s13018-018-0765-6.
Concurrent cervical and lumbar spinal canal stenosis is known as tandem spinal stenosis (TSS). As research on TSS is limited, there is no consensus on the optimal surgical approach to this problem. We evaluated the prevalence and clinical characteristics of TSS in patients with symptomatic lumbar spinal canal stenosis (LCS).
The authors performed a retrospective analysis of the outcomes of 565 patients who underwent lumbar surgeries performed for symptomatic LCS. In all the patients, both the cervical and lumbar regions were evaluated preoperatively, and we compared TSS patients and non-TSS patients in terms of multiple clinical parameters. In the TSS patients, we investigated the ratio and clinical outcomes of additional cervical surgeries performed on TSS patients.
Two hundred two cases (35.8%) were considered to be TSS. Twenty-eight patients (5.0%) underwent a cervical operation during the follow-up period. There were no differences between the radiographic TSS patients and non-TSS patients in terms of preoperative lumbar-Japanese Orthopedic Association (L-JOA) scores, postoperative L-JOA scores, and the L-JOA recovery rate (14.8 ± 4.4 points vs 14.2 ± 4.6 points, 23.9 ± 4.3 points vs 23.1 ± 4.5 points, 63.7 ± 28.2% vs 60.3 ± 27.9%, respectively), while the TSS group included a greater number of hypertension cases. The recovery rate L-JOA scores of patients who underwent additional cervical surgeries were significantly lower compared with the rate of patients who experienced treatment for only lumbar lesions (62.8 ± 25.8% vs 39.8 ± 35.5%, p = 0.0003). However, additional cervical surgery still improved both the cervical myelopathy-Japanese Orthopedic Association (C-JOA) and L-JOA scores in TSS patients with symptomatic cervical lesion (from 10.3 ± 2.8 points to 12.1 ± 3.0 points, p = 0.0302; from 14.8 ± 7.3 points to 19.9 ± 5.0 points, p = 0.0331, respectively). In these patients, there were no significant differences in the recovery rate of both C-JOA and L-JOA scores between the single-stage surgery group and the staged surgery group (40.7 ± 35.8% vs 20.7 ± 16.1%; 50.9 ± 25.1% vs 34.2 ± 39.3%, respectively).
Radiographic co-existing cervical stenosis did not affect surgical outcomes for LCS, although symptomatic cervical lesion affected neurological score after lumbar surgery. An additional surgery for cervical lesion significantly improved neurological findings in TSS patients.
颈椎和腰椎椎管狭窄并存被称为串联性椎管狭窄（TSS）。由于对TSS的研究有限，对于解决这一问题的最佳手术方法尚无共识。我们评估了有症状的腰椎管狭窄（LCS）患者中TSS的患病率和临床特征。
作者对565例因有症状的LCS接受腰椎手术的患者的手术结果进行了回顾性分析。对所有患者术前均对颈椎和腰椎区域进行了评估，并在多个临床参数方面比较了TSS患者和非TSS患者。在TSS患者中，我们调查了对TSS患者进行额外颈椎手术的比例和临床结果。
202例（35.8%）被认为是TSS。28例患者（5.0%）在随访期间接受了颈椎手术。影像学TSS患者和非TSS患者在术前腰椎日本骨科协会（L-JOA）评分、术后L-JOA评分和L-JOA恢复率方面无差异（分别为14.8±4.4分对14.2±4.6分、23.9±4.3分对23.1±4.5分、63.7±28.2%对60.3±27.9%），而TSS组高血压病例较多。接受额外颈椎手术患者的L-JOA评分恢复率与仅接受腰椎病变治疗患者的恢复率相比显著更低（62.8±25.8%对39.8±35.5%，p = 0.0003）。然而，对于有症状颈椎病变的TSS患者，额外的颈椎手术仍改善了颈椎脊髓病日本骨科协会（C-JOA）和L-JOA评分（分别从10.3±2.8分提高到12.1±3.0分，p = 0.0302；从14.8±7.3分提高到19.9±5.0分，p = 0.0331）。在这些患者中，单阶段手术组和分期手术组的C-JOA和L-JOA评分恢复率无显著差异（分别为40.7±35.8%对20.7±16.1%；50.9±25.1%对34.2±39.3%）。
影像学上并存的颈椎狭窄不影响LCS的手术结果，尽管有症状的颈椎病变会影响腰椎手术后的神经学评分。对颈椎病变进行额外手术可显著改善TSS患者的神经学表现。
