Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.
Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
BMC Musculoskelet Disord. 2024 Aug 14;25(1):640. doi: 10.1186/s12891-024-07718-1.
Tandem spinal stenosis (TSS) is a condition characterized by the narrowing of the spinal canal in multiple segments of the spine. Predominantly observed in the cervical and lumbar regions, TSS also manifests in the conjunction of the cervical and thoracic spine. The simultaneous occurrence of cervical and thoracic spinal stenosis engenders intricate symptoms, potentially leading to missed and delayed diagnosis. Furthermore, the presence of tandem cervical and thoracic stenosis (TCTS) introduces a notable impact on the decision-making calculus of surgeons when contemplating either one-staged or two-staged surgery. Currently, there is no agreed-upon strategy for surgical intervention of TCTS in the literature.
Medical databases in English (Pubmed, Web of Science, Embase, the Cochrane Database of Systematic Reviews) and Chinese (CNKI, Wanfang Data, VIP CMJD) were searched using Medical Subject Heading queries for the terms "tandem cervical and thoracic stenosis", "cervical stenosis AND thoracic stenosis", "tandem spinal stenosis" and "concomitant spinal stenosis" from January 1980 to March 2023. We included studies involving adult individuals with TCTS. Articles exclusively focused on disorders within a single spine region or devoid of any mention of spinal disorders were excluded.
Initially, a total of 1625 literatures underwent consideration for inclusion in the study. Following the elimination of the duplicates through the utilization of EndNote, and a meticulous screening process involving scrutiny of abstracts and full-texts, 23 clinical studies met the predefined inclusion criteria. Of these, 2 studies solely focused on missed diagnosis, 19 studies exclusively discussed surgical strategy for TCTS, and 2 articles evaluated both surgical strategy and missed diagnosis.
Our study revealed a missed diagnosis rate of 7.2% in TCTS, with the thoracic stenosis emerging as the predominant area susceptible to oversight. Therefore, the meticulous identification of TCTS assumes paramount significance as the inaugural step in its effective management. While both one-staged and two-staged surgeries have exhibited efficacy in addressing TCTS, the selection of the optimal surgical plan should be contingent upon the individualized circumstances of the patients.
串联性椎管狭窄症（TSS）是一种以脊柱多个节段椎管狭窄为特征的疾病。TSS 主要发生在颈椎和腰椎区域，但也会出现在颈椎和胸椎交界处。颈椎和胸椎椎管狭窄同时发生会产生复杂的症状，可能导致漏诊和延误诊断。此外，当考虑进行一期或二期手术时，串联性颈椎和胸椎狭窄症（TCTS）的存在会显著影响外科医生的决策。目前，文献中尚无关于 TCTS 手术干预的共识策略。
我们使用 Medical Subject Heading 检索词“tandem cervical and thoracic stenosis”、“cervical stenosis AND thoracic stenosis”、“tandem spinal stenosis”和“concomitant spinal stenosis”，在英文数据库（Pubmed、Web of Science、Embase、the Cochrane Database of Systematic Reviews）和中文数据库（CNKI、万方数据、VIP CMJD）中检索 1980 年 1 月至 2023 年 3 月间的医学文献。我们纳入了涉及 TCTS 成年患者的研究。排除仅关注单一脊柱区域疾病或未提及脊柱疾病的文章。
最初共纳入了 1625 篇文献进行研究。通过 EndNote 消除重复项，以及仔细筛选摘要和全文后，有 23 项临床研究符合预先设定的纳入标准。其中，2 项研究仅关注漏诊，19 项研究专门讨论 TCTS 的手术策略，2 篇文章同时评估了手术策略和漏诊。
我们的研究显示 TCTS 的漏诊率为 7.2%，其中胸椎狭窄是最容易被忽视的部位。因此，细致地识别 TCTS 对于其有效管理至关重要，是第一步。虽然一期和二期手术均已被证实对 TCTS 有效，但最佳手术方案的选择应取决于患者的个体情况。
