Delayed Diagnosis of Tandem Spinal Stenosis: A Retrospective Institutional Review

Abstract

Background: Tandem spinal stenosis (TSS) is defined as simultaneous spinal stenosis in the cervical, thoracic, and/or lumbar regions and may present with both upper and lower motor neuron symptoms, neurogenic claudication, and gait disturbance. Current literature has focused mainly on the prevalence of TSS and treatment methods, while the incidence of delayed TSS diagnosis is not well defined. The purpose of this study was to determine the incidence of delayed TSS diagnosis at our institution and describe the clinical characteristics commonly observed in their particular presentation. Methods: Following institutional review board approval, an institutional billing database review was performed for patients who underwent a spinal decompression procedure between 2006 and 2016. Thirty-three patients who underwent decompression on 2 separate spinal regions within 1 year were included for review. Patients with delayed diagnosis of TSS following the first surgery were differentiated from those with preoperative diagnosis of TSS. Results: TSS requiring surgical decompression occurred in 33 patients, with the incidence being 2.06% in this cohort. Fifteen patients received a delayed diagnosis after the first surgical decompression (45%) and were found to have a longer interval between decompressions (7.6 6 2.1 months versus 4.01 6 3 months, P ¼ .0004). Patients undergoing lumbar decompression as the initial procedure were more likely to have a delayed diagnosis of TSS (8 versus 2 patients, P ¼ .0200). The most common presentation of delayed TSS was pain and myelopathic symptoms that persisted after decompressive surgery. Conclusion: TSS should remain within the differential diagnosis for patients at initial presentation of spinal stenosis. In addition, suspicion of TSS should be heightened if preoperative symptoms fail to expectedly improve following decompression even if overt myelopathic signs are not present.

Tandem Spinal Stenosis at the Brazzaville Academic Hospital

“…For other authors, the operative order was dictated by the importance of the symptoms. They started with the most symptomatic spinal region [3,11,15]. In his study, Luo [16] noted a faster decompensation of cervical signs in patients previously operated on at the lumbar level, which he did not find in patients whose procedure was reversed.…”

“…This opinion is shared by Krishnan [17]. The postoperative evolution, satisfactory in a large number of studies, had not shown a significant difference whatever the mode or order of the surgical gestures [9,11,12,15]. The determining elements of this evolution would be the duration of evolution of the signs and the speed of the realization of the surgical act according to Zulkefli [15].…”

“…The surgery was done in one stage in two of our patients, which was the case in some patients of Bhandutia [11] and Kikuike [12]. In the other 14 cases, surgeries have been performed in two stages.…”

“…Probably for the same reasons, Bhandutia [11] had adopted this attitude for most of her patients. For other authors, the operative order was dictated by the importance of the symptoms.…”

“…The participation of two surgical teams as proposed by some authors including Bhandutia [11], kikuike [12], Krishnan [17], would allow more this time. This procedure is valid in our opinion only for cervico-lumbar lesions addressed by the posterior approach.…”