Abstract
PurposeTo report the techniques and safety of one-staged combined decompression for the patients with tandem spinal stenosis (TSS) at cervical and thoracic spine.MethodsSixteen TSS subjects, who received combined decompression from Aug 2005 to Feb 2012, were reviewed. The essentials of our surgical strategy included: choosing patients with TSS from cervical to upper or middle thoracic spine, using one single posterior incision, simplifying surgical maneuvers and performing circumferential decompression for thoracic compression if it was indicated. The Japanese Orthopedic Association (JOA) scale for cervical myelopathy was employed to evaluate the neurological status, and Hirabayashi’s system to assess neurological recovery rate.ResultsThe average operation duration, blood loss and postoperative hospitalization were 242.8 ± 89.9 min, 1581.3 ± 1237.2 ml and 11.9 ± 7.5 days, respectively. Six subjects (37.5 %) suffered instant neurological deterioration. Other complications included cerebrospinal fluid leakage (10 subjects, 62.5 %), new radiculopathy (two subjects), urinary infection, lung infection and pulmonary thromboembolism. Four subjects received extra-thoracic decompression due to the remaining anterior compression in one subject and new emerging compression in other three subjects. Eventually, mean JOA score was elevated from 9.8 ± 2.1 to 13.7 ± 2.7 after this procedure, and the neurological recovery of seven subjects was rated as excellent, four as good, two as fair, three as unchanged or deteriorated. The overall recovery rate was 53.7 %.ConclusionCombined cervico-thoracic decompression could provide fair neurological outcomes for patients with cervico-thoracic TSS, but it was complicated with high rate of undesirable postoperative events. So, more efforts should be done against its eventful postoperative course before its wide application.
Highlights
Spinal stenosis is an age-associated disease and can sometimes involve more than one spinal segment, a situation which is termed as tandem spinal stenosis (TSS) [1, 2]
Imaging work-ups showed that the tandem stenosis ran from cervical spine to upper or middle thoracic spine in all recruited subjects and thoracic OPLL was found in 13 subjects, among whom 10 subjects presented with cervical OPLL
This study found that the postoperative courses after combined cervico-thoracic decompression were quite eventful, even though all the operations were performed by experienced surgeons
Summary
Spinal stenosis is an age-associated disease and can sometimes involve more than one spinal segment, a situation which is termed as tandem spinal stenosis (TSS) [1, 2]. Eur Spine J (2017) 26:374–381 available for the cervico-thoracic TSS, which are onestaged and two-staged decompressions. Chen et al [5] did the pioneering research for one-staged surgery in 15 patients with cervicothoracic TSS, and regarded it as an aggressive surgical strategy. They have emphasized on the preoperative communication with patients on the impact of perioperative complications and postoperative consequences on its outcome. We report the clinical outcomes of onestaged combined decompression via a single posterior incision, which could be regarded as an attempt to simplify the procedure
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