Abstract
ABSTRACT Objective: To conduct a multicenter analysis of the effectiveness of surgical tactics for treating patients with symptomatic tandem stenosis of the cervical and lumbar spine, based on a differentiated clinical-instrumental algorithm. Methods: The study included 97 patients with symptomatic tandem stenosis of the cervical and lumbar spine. The patients were allocated into 2 groups. The main prospective follow-up group (Group I) consisted of patients (n=46) who had undergone staged decompression/stabilization surgery according to the surgical tactics developed based on the differential clinical-instrumental algorithm. The clinical comparison group (Group II) (n=51) consisted of retrospectively recruited patients who, depending on the prevailing clinical condition, underwent primary surgery at the cervical level (29 cases) or at the lumbar level (22 cases). Results: The comparative analysis in Group I revealed significantly better parameters in the clinical and instrumental data. The total rates of postoperative surgical complications in the cervical and lumbar spine were 15% in Group I and 68% in Group II (p=0.0014). Conclusion: The multicenter analysis of the clinical-instrumental algorithm based on differential application of decompression/stabilization techniques enabled more rational and radical surgery, with less adverse outcomes, leading to earlier start of rehabilitation in the prospective group of patients (Group I), and an objective improvement in long-term clinical and functional outcomes. Level of Evidence II; Prognostic Studies - Investigating the Effect of a Patient Characteristic on Disease Outcome.
Highlights
A comprehensive clinical evaluation of neurological symptoms directly arising from the degree of narrowing of the vertebral canal and intervertebral foramen combined with tandem stenoses is used to determine the dominant role in the surgical tactics, and the effectiveness of the intervention
In order to optimize surgical outcomes and eliminate potential adverse effects, assessed retrospectively, we proposed a surgical tactic based on a differential clinical-instrumental algorithm for treating patients with symptomatic tandem stenosis of the cervical and lumbar spine
The developed surgical tactics based on the preoperative clinical-instrumental algorithm for the treatment of the patients with symptomatic tandem stenosis of the cervical and lumbar spine significantly improved the functional state of patients
Summary
Degenerative spine diseases, vertebrogenic compression syndromes, and their surgical treatment still remain ones of the most topical issues in neurosurgery, spinal surgery, traumatology, and orthopedics.1-3The multicomponent clinical symptoms and various pathophysiological manifestations of the degenerative process at the cervical and lumbar level occur as isolated or more complex combined tandem stenoses, which is a pathological narrowing of the central spinal canal, lateral recess or intervertebral foramen. Surgical treatment of degenerative spinal stenosis traditionally uses isolated decompression and decompression combined with stabilization of spinal motion segments (SMSs) using implants. Conservative treatment of stenosis provides some improvement only in the early stages of the disease. The introduction of minimally invasive microsurgical techniques undoubtedly brought a more positive perspective for the treatment of these patients.13,14A comprehensive clinical evaluation of neurological symptoms directly arising from the degree of narrowing of the vertebral canal and intervertebral foramen combined with tandem stenoses is used to determine the dominant role in the surgical tactics, and the effectiveness of the intervention. Neuroimaging techniques have significantly expanded the diagnostic capabilities for early verification of degenerative spinal diseases, which in turn, has led to an increase in the number of surgical interventions for spinal stenosis.. The multicomponent clinical symptoms and various pathophysiological manifestations of the degenerative process at the cervical and lumbar level occur as isolated or more complex combined tandem stenoses, which is a pathological narrowing of the central spinal canal, lateral recess or intervertebral foramen.. Surgical treatment of degenerative spinal stenosis traditionally uses isolated decompression and decompression combined with stabilization of spinal motion segments (SMSs) using implants.. A comprehensive clinical evaluation of neurological symptoms directly arising from the degree of narrowing of the vertebral canal and intervertebral foramen combined with tandem stenoses is used to determine the dominant role in the surgical tactics, and the effectiveness of the intervention.. Neuroimaging techniques have significantly expanded the diagnostic capabilities for early verification of degenerative spinal diseases, which in turn, has led to an increase in the number of surgical interventions for spinal stenosis.
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