Presence of Undiagnosed Cervical Myelopathy in Patients referred for Surgical Evaluation of Lumbar Stenosis

Abstract

Introduction: Lumbar stenosis is a common clinical entity, i.e., being diagnosed with increasing frequency in our aging population in the United States. The process of spondylitic degeneration that causes lumbar stenosis may also give rise to concurrent cervical stenosis, resulting in so-called tandem stenosis. Symptomatic tandem spinal stenosis is characterized clinically by a combination of claudication and progressive gait disturbance with signs of mixed myelopathy and polyradiculopathy in both the upper and lower extremities. Materials and methods: A retrospective review of 361 patients, referred to our clinic for evaluation of lumbar stenosis over a period of 4 years, was conducted. Data collection consisted of detailed chart review and tabulation of the duration of symptoms, course of nonsurgical therapy, sensory and motor deficits, gait/ balance disturbances, upper motor neuron signs, and diagnostic imaging studies. Patients with signs and symptoms suggestive of cervical spondylitic myelopathy underwent confirmatory diagnostic imaging studies. Results: Twenty-one of the 361 patients (5.8%) were found to have symptomatic tandem stenosis with clear clinical evidence of cervical myelopathy. Twelve of the 21 patients underwent cervical decompression; of these four underwent cervical decompression followed by lumbar decompression, and one patient underwent cervical decompression followed by thoracic decompression. Eight of the 21 patients underwent lumbar decompression only. One patient underwent lumbar decompression followed by cervical decompression. Conclusion: The possibility of concurrent disease in both the cervical and lumbar spines reinforces the need for a thorough history and physical examination. Recognition and diagnosis of tandem stenosis is critical in determining the correct surgical sequencing and technique for treatment as spinal cord compression from cervical stenosis has significant associated morbidity and mortality. The 5.8% rate of tandem stenosis in ORIGINAL ARTICLE 1-4Consultant, 5,6Nurse, 7Professor 1Kauvery Spine Centre, Kauvery Hospital, Chennai, Tamil Nadu, India 2-6Section of Neurosurgery, University of Chicago, Chicago Illinois, USA 7Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA Corresponding Author: Gopalakrishnan Balamurali Consultant, Kauvery Spine Centre, Kauvery Hospital, Mylapore Chennai, Tamil Nadu, India, Phone: +919840480529, e-mail: drgbalamurali@gmail.com 10.5005/jp-journals-10039-1082 this series places it in the lower end of the range from previous reports. Furthermore, only 3% of all patients referred for surgical evaluation of lumbar stenosis were ultimately found to have cervical stenosis requiring surgical decompression.