Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, No. 5, Fusing Street, Gueishan, Taoyuan, 333, Taiwan.
Department of Orthopaedic Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Affiliated to the Tamil Nadu Dr. MGR Medical University, Chennai, Tamil Nadu, India.
Eur Spine J. 2019 Jan;28(1):61-68. doi: 10.1007/s00586-018-5795-6. Epub 2018 Oct 17.
Tandem spinal stenosis (TSS) refers to lumbar and cervical spinal canal stenosis. Staged surgery is often chosen, but sometimes, mere decompression of one stenosis is adequate to relieve symptoms. Therefore, we intend to analyze whether starting with the cervical or the lumbar region is the most logical option.
We retrospectively reviewed the data of 47 patients with TSS, having first-stage decompression for the most symptomatic stenosis, and classified into two groups (Group A: lumbar decompression first, Group B: cervical decompression first). Postoperative outcomes were analyzed for at least 2 years, and they were cautiously watched for symptoms of the non-operated stenosis; if such symptoms were debilitating, second-stage surgery for the non-operated stenosis was done.
The demographic characteristics of Group A (n = 11) and Group B (n = 36) were comparable. One patient (9%) in Group A and 25 patients (67%) in Group B had resolution of symptoms and good functional recovery. The need for a second-stage surgery for the non-operated stenosis was significantly high (p = 0.001) among patients in Group A. They suffered a significant worsening of both the mJOA score and the Nurick's grade; whereas, patients in Group B experienced staged improvement of both scales.
First-stage surgery for the cervical stenosis significantly lowers the need of the second-stage surgery. In contrast, if lumbar stenosis was treated first, a dramatic exacerbation of the symptoms related to the cervical stenosis can occur soon. Therefore, treatment of cervical stenosis first seems to be more appropriate. These slides can be retrieved under Electronic Supplementary Material.
串联性椎管狭窄（TSS）是指腰椎和颈椎椎管狭窄。分期手术通常是首选，但有时仅对一处狭窄进行减压即可缓解症状。因此，我们旨在分析先处理颈椎还是腰椎狭窄更为合理。
我们回顾性分析了 47 例 TSS 患者的资料，这些患者均进行了一期最严重症状的狭窄减压，将其分为两组（A 组：先腰椎减压，B 组：先颈椎减压）。对至少 2 年的术后结果进行分析，并谨慎观察非手术狭窄的症状；如果这些症状使患者致残，对非手术狭窄进行二期手术。
A 组（n=11）和 B 组（n=36）的患者的人口统计学特征相当。A 组 1 例（9%）患者和 B 组 25 例（67%）患者的症状缓解，功能恢复良好。A 组患者需要进行非手术狭窄的二期手术的比例明显更高（p=0.001）。他们的 mJOA 评分和 Nurick 分级均显著恶化；而 B 组患者的这两个评分则进行了分期改善。
一期颈椎狭窄手术显著降低了二期手术的需求。相反，如果先治疗腰椎狭窄，颈椎狭窄相关症状可能会迅速恶化。因此，先治疗颈椎狭窄似乎更合适。这些幻灯片可以在电子补充材料中检索到。
