Evaluation of Spinal Alignment and Clinical Findings for the Efficacy of One-Stage Surgery in Tandem Spinal Stenosis.

Abstract

IntroductionWe compared preoperative skeletal muscle, pre-and post-operative spinal alignment or clinical symptoms between tandem spinal stenosis (TSS) patients who underwent simultaneous cervical and lumbar decompression and lumbar spinal stenosis (LSS) patients who underwent only lumbar decompression and the efficacy of one-stage surgery was examined.MethodsThis study included 82 patients, identifying 13 patients for the TSS group (mean age 77.2 years) and 69 patients for the LSS group (mean age 72.2 years). One-stage decompression surgery was performed on both groups. The spinal alignments were evaluated using Lumbar scoliosis (LS), Sagittal vertical axis (SVA), Lumbar lordosis (LL), Pelvic tilt (PT), Pelvic incidence (PI), and Sacral slope (SS). The clinical symptoms were evaluated using the visual analogue scale (VAS) score for low back pain (LBP), the Japanese Orthopedic Association scoring system (JOA score), the Roland-Morris Disability Questionnaire (RDQ), the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Oswestry Disability Index (ODI).ResultsThe amount of bleeding was not significantly different between the two groups (p > .05). SVA, LL, PT, and SS were significantly improved in the LSS group (p < 0.05). In the TSS group, SVA, LL, PT, and SS tended to improve, but without significant differences. The proportion of JOABPEQ gait dysfunction that was difficult to climb stairs was 83% in the TSS group, and social life disturbance that was difficult to engage in ordinary activities was 67% in the TSS group, which was significantly higher than that in the LSS group (p < .05). Although clinical symptoms improved by surgery in both groups (p < .05), there was no significant difference in the degree of clinical symptom improvement before and after surgery (p > .05).ConclusionsOne-stage surgery for TSS is effective because it has the same intraoperative bleeding volume as LSS alone and is minimally invasive. It also improves forward-leaning posture and clinical symptoms equivalent to LSS alone.