TANDEM SPINAL STENOSIS: DILEMMA IN DIAGNOSIS AND MANAGEMENT

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TANDEM SPINAL STENOSIS DILEMMA IN DIAGNOSIS AND
MANAGEMENT

• Selhan KARADERELER, MD
• Kursat GANIYUSUFOGLU, MD
• Levent ULUSOY, MD
• Cagatay OZTURK, MD
• Ahmet ALANAY, MD
• Azmi HAMZAOGLU, MD
• Istanbul Spine Center
• Florence Nightingale Hospital
• Istanbul-TURKEY

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INTRODUCTION

• Spondylotic degeneration can manifest as tandem
  (concurrent) cervical, thoracic and/or lumbar
  spinal stenosis.
• The primary manifestations include neurogenic
  claudication, gait disturbance and a mixture of
  findings of myelopathy and polyradiculopathy in
  both the upper and lower extremities.

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PURPOSE

• To report the existence and management of tandem
  (concurrent) cervical, thoracic and/or lumbar
  spinal stenosis.
• Between the years 2002 2008
• 49 patients (34 women and 15 men) with tandem
  spinal stenosis of at least two locations of 3
  regions of the spine in a series of 758 patients
  who underwent surgery for spinal stenosis (a
  frequency of 6.4 ).

PATIENT SAMPLE
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METHODS

• The mean age 67 years (51-80).
• In this group of patients, a staged surgery for
  cervical, thoracic and lumbar spinal stenosis was
  performed.
• The clinical results were evaluated according to
• Japanese Orthopedic Association (JOA) score for
  cervical and thoracic stenosis
• Oswestry Disability Score for lumbar stenosis.

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RESULTS

• The mean follow-up period 51.4 (24-96) m
• There was concurrent spinal stenosis of
• cervical and lumbar spine 38 patients
• cervical and thoracic spine 2 patients
• thoracic and lumbar spine 5 patients
• cervical, thoracic and lumbar spine 4
  patients.

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RESULTS

• The JOA score
• 8.1 preoperatively
• 11.8 in discharge
• 12.7 at final follow-up.

• Oswestry Disability Score
• 58.1 preoperatively
• 29 in discharge
• 19.3 at latest follow-up.

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RESULTS

• There were no infections in patients.
• Intraoperative and postoperative complications
  included
• one death
• one dural tear
• one late deep venous thrombosis.
• All patients had significant improvement in
  myelopathy and were ambulatory at the final
  follow-up.

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CONCLUSION

• Although tandem spinal stenosis occurred
  relatively infrequent, its potential presence
  should not be overlooked.
• A remarkable incidence of thoracic stenosis (22
  of all tandem cases) has been observed and the
  diagnosis might be difficult especially in
  patients with concurrent cervical stenosis.

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THANK YOU