Coexisting Cervical and Lumbar Spinal Stenosis: Diagnosis and Management

Abstract

An attempt has been made to identify and manage patients symptomatic from both cervical and lumbar spinal stenosis. The order of operative intervention was related to the degree of myelopathy and radiculopathy. Patients requiring cervical surgery first had absolute stenosis with a spinal canal equal to or less than 10 mm in anteroposterior diameter. Those requiring lumbar surgery first presented with stenosis and a canal between 11 and 13 mm in depth. In the latter group, patients presented with radiculopathy in their upper and lower extremities. A significant portion (50%) had intermittent neurogenic claudication (INC). Motor and sensory changes were severe in those with absolute as compared to relative stenosis. After cervical laminectomy, myelopathy improved or stabilized, and the subsequent lumbar decompression could be completed with less risk. Cervical cord decompression often resulted in improvement in lumbar symptoms with resolution of pain, spasticity, and sensory deficits of myelopathic origin. However, latent symptoms of INC caused by lumbar stenosis were not affected by cervial decompression and increased in severity. Electrodiagnostic studies were helpful in that somatosensory evoked potentials showed conduction delays in the cervical cord in patients with significant disease. The identification of motor neuron disease and peripheral neuropathies was essential. The surgical management included extensive, multiple level laminectomy, unroofing of the lateral recesses, and foraminotomy. Neurolysis and untethering of the spinal cord was essential. Significant improvement was shown by 90% of these patients.

The effects of surgery on locomotion in elderly patients with cervical spondylotic myelopathy

“…Descriptions of developmental combined cervical and lumbar spondylosis and tandem lumbar and cervical spinal stenosis caused by osseous or developmental problems of the spinal canal are available in the literature [23][24][25][26]. However, degenerative changes in elderly patients, including thickening of the yellow ligament, facet joint hypertrophy and disc bulging, are more common causes of myelopathy compared with osseous or developmental problems.…”

Prevention, identification, and treatment of perioperative spinal cord injury

“…The method of intubation is critical especially in patients with severely tight cervical canals such as those with congenital stenosis, diffuse idiopathic skeletal hyperostosis, OPLL, and also those with severe spondylosis of the lumbar spine, as there is a correlation with spondylosis of the cervical spine. 24,54 Other patients at risk for SCI from intubation, or iatrogenic worsening of an already existing SCI, are those with potentially unstable cervical spines who have rheumatoid arthritis, Down syndrome, traumatic cervical spine injuries, and hypermobile transition zones between fused regions, such as in Klippel-Feil syndrome. In either group of patients, a careful fiberoptic endotracheal intubation without hyperextension of the neck is an important consideration to prevent SCI.…”

Laminectomy for cervical myelopathy

“…[4][5][6][7][8][9][10] Patients with lumbar stenosis over 65 years of age should routinely have cervical studies performed as 10% of these individuals will have significant tandem cervical stenosis. 11 For these patients with myeloradiculopathy, male usually outnumber female patients -2:1. Radicular complaints include pain, numbness, tingling, or weakness in a specific or varied dermatomal distribution.…”

“…43 Facet fusions may prevent or treat instability following laminectomy. 11,[46][47][48] Fusion occurred in 79% of Miyazaki et al's 48 46 patients following laminectomy, where noninstrumented facet fusions were performed. Postlaminectomy, Luque rectangle-facet fusion was successful in 90% of cases compared with a 96% fusion rate following facet wiring with a braided titanium cable.…”