Case Western Reserve University School of Medicine, 9500 Euclid Ave, Cleveland, OH, 44195, USA; Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
Case Western Reserve University School of Medicine, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
Spine J. 2022 Nov;22(11):1788-1800. doi: 10.1016/j.spinee.2022.07.088. Epub 2022 Jul 16.
Tandem spinal stenosis (TSS) refers to a narrowing of the spinal canal in distinct, noncontiguous regions. TSS most commonly occurs in the cervical and lumbar regions. Decompressive surgery is indicated for those with cervical myelopathy or persistent symptoms from lumbar stenosis despite conservative management. Surgical management typically involves staged procedures, with cervical decompression taking precedence in most cases, followed by lumbar decompression at a later time. However, several studies have shown favorable outcomes in simultaneous decompression.
The aim of this study is to provide a literature review and compare surgical outcomes in patients undergoing staged vs simultaneous surgery for TSS.
STUDY DESIGN/SETTING: Systematic literature review.
A systematic review using PRISMA guidelines to identify original research articles for tandem spinal stenosis. PubMed, Cochrane, Ovid, Scopus, and Web of Science were used for electronic literature search. Original articles from 2005 to 2021 with more than eight adult patients treated surgically for cervical and lumbar TSS in staged or simultaneous procedures were included. Articles including pediatric patients, primarily thoracic stenosis, stenosis secondary to neoplasm or infectious disease, minimally invasive surgery, and non-English language were excluded. Demographic, perioperative, complications, functional outcome, and neurologic outcome data including mJOA (modified Japanese Orthopaedic Association), Nurick grade (NG), and ODI (Oswestry disability index), were extracted and summarized.
A total of 667 articles were initially identified. After preliminary screening, 21 articles underwent full-text screening. Ten articles met our inclusion criteria. A total of 831 patients were included, 571 (68%) of them underwent staged procedures, and 260 (32%) underwent simultaneous procedures for TSS. Mean follow-ups ranged from 12 to 85 months. There was no difference in estimated blood loss (EBL) between staged and simultaneous groups (p=.639). Simultaneous surgeries had shorter surgical time than staged surgeries (p<.001). Mean changes in mJOA, NG, and ODI was comparable between staged and simultaneous groups. Complications were similar between the groups. There were more major complications reported in simultaneous operations, although this was not statistically significant (p=.301).
Staged and simultaneous surgery for TSS have comparable perioperative, functional, and neurologic outcomes, as well as complication rates. Careful selection of candidates for simultaneous surgery may reduce the length of stay and consolidate rehabilitation, thereby reducing hospital-associated costs.
串联性椎管狭窄（TSS）是指椎管在不同的、不连续的区域出现狭窄。TSS 最常发生在颈椎和腰椎。对于那些患有颈髓病或腰椎狭窄症经保守治疗后仍有持续症状的患者，需要进行减压手术。手术治疗通常涉及分期手术，在大多数情况下，颈椎减压优先，然后在稍后时间进行腰椎减压。然而，一些研究表明同期减压的效果良好。
本研究旨在提供一份文献综述，并比较分期手术与同期手术治疗 TSS 的手术结果。
研究设计/设置：系统文献回顾。
采用 PRISMA 指南进行系统文献检索，以确定针对串联性椎管狭窄的原始研究文章。使用 PubMed、Cochrane、Ovid、Scopus 和 Web of Science 进行电子文献搜索。纳入了 2005 年至 2021 年期间，采用分期或同期手术治疗颈椎和腰椎 TSS 的 8 例以上成人患者的原始文章。排除了包括儿科患者、主要胸椎狭窄、继发于肿瘤或感染性疾病的狭窄、微创外科手术以及非英语语言的文章。提取并总结了人口统计学、围手术期、并发症、功能结局和神经功能结局数据，包括 mJOA（改良日本矫形协会）、Nurick 分级（NG）和 ODI（Oswestry 残疾指数）。
共初步确定了 667 篇文章。初步筛选后，有 21 篇文章进行了全文筛选。符合纳入标准的文章共 10 篇。共纳入 831 例患者，其中 571 例（68%）接受分期手术，260 例（32%）接受同期手术治疗 TSS。平均随访时间为 12 至 85 个月。分期组和同期组的估计失血量（EBL）无差异（p=.639）。同期手术的手术时间短于分期手术（p<.001）。分期组和同期组 mJOA、NG 和 ODI 的平均变化相似。两组并发症相似。同期手术报告的主要并发症较多，但无统计学意义（p=.301）。
TSS 的分期和同期手术具有相似的围手术期、功能和神经功能结局以及并发症发生率。对于同期手术的候选者进行仔细选择可能会缩短住院时间并整合康复治疗，从而降低与住院相关的成本。
