Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
World Neurosurg. 2020 Nov;143:546-552.e1. doi: 10.1016/j.wneu.2020.06.021. Epub 2020 Jun 8.
A scarcity of data has been reported on tandem thoracic lumbar stenosis, which might be related to either the rarity or underdiagnosis of the condition. We have presented a systematic review of the clinical presentation, diagnosis, and treatment patterns for patients with symptomatic tandem thoracic and lumbar stenosis.
A PubMed/MEDLINE search was performed to find reports of patients with symptomatic tandem thoracic and lumbar stenosis.
The review identified 10 studies with a total of 48 patients with tandem thoracic and lumbar stenosis. Most patients (n = 41; 85%) had had tandem stenosis diagnosed at the initial investigation, with 71% of the reports citing ossification of the ligamentum flavum as a contributing etiology. A few patients (n = 7; 15%) had had thoracic lesions diagnosed after neurologic deterioration that had occurred after lumbar surgery for previously suspected isolated lumbar stenosis. Surgical management varied from isolated thoracic decompression, staged decompression, and simultaneous decompression. Most patients (n = 41; 87%) showed improved neurologic status after surgery.
Ossification of the ligamentum flavum might play a key role in the pathogenesis of the condition. Most patients with tandem thoracic and lumbar stenosis will show improvement after surgical decompression. Although the limited evidence available has raised concerns regarding neurologic deterioration after initial lumbar decompression in patients with coexisting thoracic stenosis, the data are insufficient to definitively determine an optimal surgical strategy. Further research is needed to identify the optimal diagnostic and management criteria for patients with symptomatic tandem thoracic and lumbar stenosis.
串联性胸腰椎狭窄症的数据较为匮乏，这可能与该疾病的罕见性或漏诊有关。我们对有症状的串联性胸腰椎狭窄症患者的临床表现、诊断和治疗模式进行了系统评价。
对 PubMed/MEDLINE 进行了检索，以查找有症状的串联性胸腰椎狭窄症患者的报告。
该综述共纳入了 10 项研究，总计 48 例串联性胸腰椎狭窄症患者。大多数患者（n=41；85%）在初始检查时就已诊断为串联性狭窄，其中 71%的报告指出黄韧带骨化是导致该疾病的一个病因。少数患者（n=7；15%）在腰椎手术后出现神经功能恶化后，才诊断出胸段病变，而这些患者之前被怀疑患有孤立性腰椎狭窄症。手术治疗方式从单纯的胸椎减压、分期减压到同时减压不等。大多数患者（n=41；87%）在手术后神经功能状况得到改善。
黄韧带骨化可能在该疾病的发病机制中起关键作用。大多数有症状的串联性胸腰椎狭窄症患者在接受手术减压后会有改善。尽管目前有限的证据对在合并胸段狭窄的患者中，初始腰椎减压后出现神经功能恶化的情况表示担忧，但这些数据不足以确定最佳的手术策略。需要进一步的研究来确定有症状的串联性胸腰椎狭窄症患者的最佳诊断和管理标准。
