Symptomatic Tandem Stenosis Research Articles

Evaluation of intravascular therapy for cerebral ischemic tandem stenosis

Objective: To investigate the efficacy and the safety of intravascular therapy for cerebrovascular ischemic tandem stenosis. Methods: Clinical data of 35 patients with symptomatic anterior circulation and posterior circulation tandem stenosis who received intravascular therapy for two sites of stenosis at the same time at Department of Neurosurgery of Peking University First Hospital from January 2013 to December 2018 were analyzed retrospectively. There were 27 males and 8 females,aged (65.6±9.4)years (range:47 to 81 years).There were 14 cases of anterior circulation tandem stenosis and 21 of posterior circulation tandem stenosis.The medical records were collected with emphasis on postoperative symptoms,imaging manifestations and modified Rankin scale(mRS) scores. Results: Sixty-eight stents were implants in to 35 patients,including 49 extracranial implants and 19 intracranial implants.The surgical success rate was 100%.The perioperative death rate was 0,and 1 patient(1/35,2.9%) had cerebral hemorrhage.All patients were followed up for 18 months.During 3 to 12 months after the intervention,1 case(1/35,2.9%) had stent restenosis,and 4 cases(4/35,11.4%) had persisted symptoms such as dizziness and weakness in limbs.All patients'mRS scores were ≤2. No new stroke occurred. During 12 to 18 months after the intervention,3 cases had in-stent restenosis,increasing the rate to 11.4% (4/35). The mRS scores of 32 patients(32/35,91.4%) were ≤2. Conclusion: Intravascular therapy for patients with symptomatic tandem stenosis is a feasible and safe procedure with good short-term outcomes.

EFFICACY OF THE CLINICAL-INSTRUMENTAL ALGORITHM IN THE TREATMENT OF SPINAL TANDEM STENOSIS

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.

MULTICENTER ANALYSIS OF SURGICAL TREATMENT EFFECTIVENESS FOR PATIENTS WITH SYMPTOMATIC TANDEM STENOSIS OF THE CERVICAL AND LUMBAR SPINE BASED ON DIFFERENTIATED CLINICAL-INSTRUMENTAL ALGORITHM

Purpose of the study — to perform a multicenter analysis of the surgical treatment effectiveness for patients with symptomatic tandem stenosis of cervical and lumbar spine based on a differentiated clinical-instrumental algorithm.Material and methods. The study included 97 patients with symptomatic tandem stenosis of cervical and lumbar spine who were divided into two groups. The main group (perspective study) included 46 patients who underwent staged decompression and stabilizing manipulations according to the surgical treatment tactics developed by authors based on differentiated clinical-instrumental algorithm. Patients were operated in three neurosurgical departments of clinics in Irkutsk, Vladivostok and Novosibirsk (Russian Federation). Control group included 51 patients enrolled retrospectively. Depending on prevailing clinical signs the first decompressive and stabilizing surgical procedure were performed on cervical spine (29 cases) or on lumbar spine (21 cases). The authors made a comparative analysis of clinical and instrumental data prior to procedure and 24 months postoperatively. Median follow up in group I was 26 months (24; 30), in group II — 40 (34; 50).The authors used the following scales to assess the outcomes: VAS scale for pain severity; Neck Disability Index (NDI) and Oswestry Disability Index (ODI) for life quality; Macnab scale for patients’ subjective satisfaction with treatment outcomes; Nurick scale for objective dynamics of neurological status; Bridwell scale for spondylolistesis rate of operated level; Pfirmann scale for rate of degenerative changes in adjacent intervertebral disc.Results. Application of the surgical tactics suggested by authors for treatment of patients with symptomatic tandem stenosis of the cervical and lumbar spine allowed to start active rehabilitation at an earlier stage in prospective group of patients which fairly positively influenced late clinical and functional outcomes. Postoperative complications rate in cervical and lumbar spine in group I amounted to 15% and in group II — to 68% (p = 0.0014).Conclusion. A differentiated and individual application of standard surgical techniques for staged procedure allowed to perform efficient decompression depending on location of pathomorphological substrate and to stabilize operated segments with lower incidence of pseudarthrosis and epidural fibrosis.

RESULTS OF STAGED SURGICAL TREATMENT OF PATIENTS WITH TANDEM STENOSIS OF THE CERVICAL AND LUMBOSACRAL SPINE

Objective. To conduct a retrospective analysis of staged surgery in patients with tandem stenosis of the cervical and lumbosacral spine, to identify causes of poor outcomes. Material and Methods . The study included 190 patients with tandem stenosis of the cervical and lumbosacral spine. Out of them 72 had symptomatic cervical and asymptomatic lumbosacral tandem stenosis (Group 1), 67 - symptomatic lumbar and asymptomatic cervical tandem stenosis (Group 2), and 51 - compression with neurological manifestations in both spine departments (Group 3). Patient’s anthropometric data, initial clinical symptoms, and duration of disease were analyzed. The intraoperative characteristics of surgical interventions and features of the postoperative period, clinical parameters and the existence of complications were evaluated. Results . Excellent and good postoperative outcomes were achieved in patients of Groups 1 and 2 with monosymptomatic tandem stenosis, in patients of Group 3 with symptomatic tandem stenosis, and in patients of all groups who underwent laminectomy and bilateral foraminotomy for bilateral symptomatic foraminal stenosis, and minimally invasive bilateral foraminotomy through unilateral approach in case of radiographic evidence of foraminal stenosis without symptoms. Conclusion . Symptomatic tandem stenosis of the cervical and lumbosacral spine is a severe nosological entity requiring meticulous removal of pathological substrate primarily in the cervical spine. The early implementation of the second stage of surgery significantly reduces neurological symptoms, relieves pain and improves quality of life in patients.

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

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.

Tandem stenosis: a cadaveric study in osseous morphology

Background Tandem stenosis is the occurrence of concurrent cervical and lumbar stenosis. The prevalence has been estimated to be from 5% to 25%. Symptomatic tandem stenosis can present with a confusing scenario of both neurogenic claudication and myelopathy symptoms. Purpose The purpose of this study was to determine 1) the prevalence of anatomic tandem stenosis in a cadaveric population, 2) if there was an associative relationship between lumbar and cervical stenosis, and 3) the positive predictive values of stenosis in one area for stenosis in the other. Study design We obtained 440 skeletally mature skeletons and examined the cervical and lumbar spines from the Hamann Todd Collection in the Cleveland Museum of Natural History. Methods For the cervical spine, we measured the mid-sagittal canal diameter using digital calipers for every level from C3 through C7. The minimum full central sagittal diameter was recorded for each level. For the lumbar spine, we measured the minimum full mid-sagittal canal diameter for every level from L1 through L5, using digital calipers. Stenosis was defined as a mid-sagittal canal diameter of less than 12 mm at at least one level. After analysis of this data, a second analysis was performed after correcting the data for contemporary body size and radiographic manifestation. Results The prevalence of tandem stenosis ranged from 0.9% to 5.4% in this population. The association of cervical and lumbar stenosis was found to be statistically significant (p<.05). Stenosis in one part of the spine positively predicts for stenosis in the other area of the spine 15.3% to 32.4% of the time. Conclusion Tandem stenosis should be considered when evaluating a patient with mixed claudication and myeloradiculopathy symptoms.