Isolated and combined degenerative tandem cervical and lumbar spinal stenoses:The paper presents detailed definitions, anatomical features and analytical data on the epidemiology and etiopathogenesis of isolated lumbar and cervical spinal stenoses and their combinations (tandem stenoses). Most widely used classifications of stenosing processes of the spine, modern X-ray imaging methods for diagnosis of spinal stenosis and approaches to surgical treatment are described. Key Words: spinal canal stenosis, isolated stenosis, tandem stenosis, degenerative diseases of the spine, diagnosis, surgical treatment.Please cite this paper as: Byvaltsev VA, Shepelev VV, Nikiforov SB, Kalinin АА. Isolated and combined degenerative tandem cervical and lumbar spinal stenoses: literature review. Hir. Pozvonoc. 2016;13(2):52-61.In Russian.

The study included 112 patients (77 males and 35 females). All patients underwent single-level discectomy with implantation of the artificial IVD prosthesis M6-C. The follow-up period was up to 36 months. Dynamic assessment of the prosthesis was based on clinical parameters (pain intensity in the cervical spine and upper extremities (visual analog scale - VAS); quality of life (Neck Disability Index - NDI)); and subjective satisfaction with the results of surgical treatment (Macnab scale) and instrumental data (range of motion in the operated spinal motion segment, degree of heterotopic ossification (McAfee-Suchomel classification), and time course of degenerative changes in the adjacent segments).

Relationship between vertebral metric parameters and outcome of surgical treatment of degenerative spondylolisthesis with multilevel lumbar intervertebral disc lesions A.A. Kalinin, V.A. Byvaltsev Objective. To analyze the relationship between radiographic parameters of spinal motion segment and clinical outcome of surgical treatment of patients with degenerative spondylolisthesis with multilevel lesions of intervertebral discs in the lumbar spine. Material and Methods. The study included 90 patients with Meyerding grade I degenerative spondylolisthesis involving more than two adjacent lumbar intervertebral discs. In Group 1 (n = 45) the rigid interspinous fixation was used, in Group 2 (n = 45)-transpedicular stabilization. Results. Significant positive nonparametric correlation was detected between the long-term surgical outcome evaluated with VAS and Oswestry scores and radiographic parameters: segmental angular amplitude, the angle of lumbar lordosis, and the degree of linear displacement of vertebrae. The rigid interspinous implant and pedicle fixation allow achieving minimum level of pain and good functional recovery with effective elimination of pathological linear displacement of vertebrae and formation of interbody bone block. Conclusion. Linear displacement of vertebrae of no more than 8 mm and sagittal range of motion in the spinal motion segment of no more than 14° permit performing interbody fusion with cage and rigid interspinous fixation, and those no more than 13 mm and 16°, respectively, transpedicular stabilization and interbody fusion with cage.

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.

Background: The technique of lateral lumbar interbody fusion for the surgical treatment of patients with degenerative diseases of the lumbar spine was developed in the early 2000s. But at the same time in modern literature there is no uniform approach to the use this technique, clinical outcomes and radiological findings are contradictory. Aims: to conduct a multicenter analysis of clinical outcomes and instrumental data of direct lateral interbody fusion (DLIF) approach combined with transcutaneous pedicle fixation in patients with single-level degenerative disc diseases of the lumbar spine. Materials and methods: The study included 103 patients (63 men and 40 women, mean age 45.8±9.7 years) who underwent surgery followed by DLIF transcutaneous pedicle fixation. The surgery was performed at neurosurgical and vertebrological departments in Irkutsk (Russia), Omsk (Russia), and Astana (Kazakhstan). Dynamic observation and comprehensive clinical and instrumental evaluation of the treatment results were carried out for an 18-month period after surgery. Results: After the simultaneous decompressive-stabilizing intervention, in all patients we detected a decrease in the severity of pain syndrome on VAS — from 6.9±1.6 to 1.7±1.2 cm (p0.001), and improved quality of life index (Oswestry) — from 21.3±6.8 to 12.3±4.4% (p0.001). The instrumental methods of examination determined the effective indirect decompression: an increase in the size of interbody gap in the middle of its department compared with the preoperative value from 8.6±3.1 to 15.7±4.2 mm (p0.001) and an increase in the area of the intervertebral foramen (on the left with an average of 98.7±32.3 and 156.8±45.1 mm2, p0.001; on the right —99.7±37.3 to 153.4±38.7 mm2, p0.001). We also registered the restoration of both the segmental (from 10.2±3.8 to 13.6±6.7°, p0.001) and regional (from 32.8±5.9 to 48.2±7.3°, р0.001) lumbar lordosis. Complete interbody fusion was diagnosed in 87 (86.4%) patients. Complications were observed in 8.7% of cases. Conclusions: DLIF technique combined with transcutaneous transpedicular stabilization has high clinical efficacy confirmed by significant reduction in the severity of pain according to VAS. The studied approach improves the quality of life of patients by Oswestry index and reveals a low number of postoperative complications. The described simultaneous minimally invasive method of surgical treatment in patients with degenerative disc diseases allows to restore the sagittal profile of the lumbar spine and implement an effective stabilization of the operated vertebral-motor segments with a high degree of formation of interbody bone block.

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Objective.To perform comparative analysis of the long-term results of using the methods of total cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) in the surgical treatment of patients with single-level degenerative diseases of cervical intervertebral discs.Material and Methods.The study included 186 patients aged 21–60 years. Independent sequential randomization (1:1) of 173 patients was performed using software. The following parameters were used to evaluate patients: the VAS score of pain syndrome severity in the cervical spine and upper extremities, the Neck Disability Index (NDI) score of the quality of life, the amplitude of movements of the operated segment, the frequency of adjacent discs degeneration and of repeated surgical interventions and adverse events.Results.In the long-term follow-up, the best clinical outcomes according to VAS and NDI data were recorded in patients from the CDA group. Their amplitude of movements in the segment remained in the physiological volume. In the ACDF group, a complete fusion was verified in 83 (93.3 %) cases. A significantly higher degree of degenerative disease of superjacent intervertebral discs was revealed in ACDF group (p < 0.01), while no significant degenerative changes were recorded in the subjacent discs (p > 0.05). The number of intraoperative and early postoperative complications did not have a statistically significant intergroup difference (p > 0.05). Symptomatic degeneration of adjacent segments was verified in 2 (2.4 %) respondents from the CDA group and in 8 (9.0 %) from the ACDF group (p < 0.001). Symptomatic adverse effects were found in 3 (3.6 %) CDA patients in the form of heterotopic ossification and in 6 (6.7 %) ACDF patients in the form of pseudoarthrosis.Conclusions.The operations of total disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) are safe and effective methods of surgical treatment of patients with single-level degenerative diseases of cervical intervertebral discs. In CDA patients, significantly better clinical results were noted, as compared with the ACDF group. The CDA method allowed preserving the normal biomechanics of the cervical spine and preventing the development of degenerative disease of adjacent segments.