Department of Orthopedics, The Third Hospital of Hebei Medical University, The Key Laboratory of Orthopedic Biomechanics of Hebei Province, 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, P. R. China.
J Orthop Surg Res. 2021 Mar 24;16(1):214. doi: 10.1186/s13018-021-02357-x.
Tandem spinal stenosis (TSS) has a complex clinical presentation, and there is no consensus on the optimal surgical strategy. This study retrospectively compared the efficacy of different staged operations and simultaneous decompression for patients with TSS.
We reviewed data from 132 patients with TSS who received surgical procedures from January 2011 to June 2018. Patients were classified into three groups according to the most symptomatic area of compression (group C: first-stage surgery for cervical compression; group L: first-stage surgery for lumbar compression; group CL: simultaneous surgery for both). Medical records were reviewed for age, gender, comorbidities, operation time, combined estimated blood loss, and time of hospitalization. The JOA-C, JOA-L, NDI, and ODI scores, and complications were also examined.
Postoperative outcomes were followed for 32.1 ± 5.4 months. There were significant differences in the re-operation rate and the interval time between the two types of staged operations (p = 0.005 and p = 0.001, respectively). There were no significant differences in gender (p = 0.639), operation time (p = 0.138), combined estimated blood loss (p = 0.116), or complications (p = 0.652) among the three groups, while the simultaneous group was significantly younger (p = 0.027), with fewer comorbidities (p < 0.001) and a shorter hospitalization time (p < 0.001). At the final follow-up, the JOA-C and JOA-L scores were increased, while the NDI and ODI scores were decreased, compared with the preoperative scores.
TSS can be effectively managed by either simultaneous or staged decompressions. First-stage surgery for cervical stenosis significantly lowers the requirement for second-stage lumbar surgery. One-stage simultaneous decompression is safe and effective with the advantage of reduce hospitalization time, without an increase in operative time or bleeding. However, the surgical indications should be strictly controlled and is recommended for younger patients with fewer comorbidities.
串联性椎管狭窄（TSS）具有复杂的临床表现，对于最佳手术策略尚无共识。本研究回顾性比较了不同分期手术和同期减压治疗 TSS 患者的疗效。
我们回顾了 2011 年 1 月至 2018 年 6 月期间接受手术治疗的 132 例 TSS 患者的数据。根据最受压部位的症状（C 组：颈椎受压一期手术；L 组：腰椎受压一期手术；CL 组：同期双节段手术）将患者分为三组。回顾病历资料，包括年龄、性别、合并症、手术时间、总估计失血量和住院时间。还检查了 JOA-C、JOA-L、NDI 和 ODI 评分以及并发症。
术后随访 32.1±5.4 个月。两种分期手术的再手术率和间隔时间有显著差异（p=0.005 和 p=0.001）。三组之间性别（p=0.639）、手术时间（p=0.138）、总估计失血量（p=0.116）或并发症（p=0.652）无显著差异，同期组患者显著更年轻（p=0.027），合并症更少（p<0.001），住院时间更短（p<0.001）。末次随访时，JOA-C 和 JOA-L 评分较术前升高，NDI 和 ODI 评分较术前降低。
TSS 可以通过同期或分期减压术有效治疗。颈椎狭窄的一期手术可显著降低二期腰椎手术的需求。一期同期减压术安全有效，具有缩短住院时间的优势，不会增加手术时间或出血。然而，应严格控制手术适应证，建议对合并症较少的年轻患者采用该术式。
