Primary cervical decompression surgery may improve lumbar symptoms in patients with tandem spinal stenosis

Ando, Kei; Kobayashi, Kazuyoshi; Nakashima, Hiroaki; Ito, Keigo; Katayama, Yoshito; Machino, Masaaki; Kanbara, Shunsuke; Ito, Sadayuki; Yamaguchi, Hidetoshi; Koshimizu, Hiroyuki; Segi, Naoki; Kato, Fumihiko

doi:10.1007/s00586-020-06693-0

Cited by 11 publications

(4 citation statements)

References 29 publications

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“…18,[30][31][32][33][34][35] Notably, in some individuals, this surgical pattern reduces the requirement for a second stage, as cervical surgery also improves lumbar symptoms. 30,31,36,37 Thus, it is important to identify the clinical characteristics and severity of compression of different populations with CLTSS to make more specific and effective interventions. Overall, our findings reflect a high burden of CLTSS among Mexican patients attending spine surgery centers due to degenerative cervical spinal disease.…”

Section: Discussionmentioning

confidence: 99%

Demographic and Clinical Characteristics of Patients With Cervical Spine Degeneration Reveal Frequent Cervicolumbar Tandem Spinal Stenosis in Mexico

et al. 2023

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Background: Limited literature exists regarding the differences in demographics, causes, comorbidities, presentation, and structural changes associated with cervical spine degeneration in patients from distinct geographic regions. The authors aimed to evaluate the demographic and clinical characteristics of patients with cervical spine degeneration admitted to a single center in Mexico.Methods: This study enrolled patients with degenerative disease of the cervical spine. Clinical data were retrieved from medical records and retrospectively characterized.Results: A total of 50 patients with cervical spine degeneration were included in the analysis. Of these, 26% were men with a median age of 54 years. Hypertension, depression, anxiety, obesity, and alcohol consumption were presented in about a quarter of the participants. In addition, we observed hypertriglyceridemia and hypercholesterolemia in 72% and 46% of participants, respectively. The median duration of symptoms was 11 months, including radicular arm/neck pain (80%), tingling (80%), reduced muscle strength (48%), and gait disturbances (48%). Forty percent of patients had 2 cervical segments radiologically involved, mainly at C5-C6, with changes such as disc herniation (88%), foraminal stenosis with nerve root compression (67%), reduced spinal canal-to-vertebral body ratio (38%), and ligamentum flavum hypertrophy (24%). Also, 22% of patients showed degenerative cervical myelopathy. Strikingly, 48% of enrolled individuals showed cervicolumbar tandem spinal stenosis, mainly in L4-L5 and L5-S1, who were generally older, had a longer duration of symptoms, and had a higher comorbidity burden, including hyperglycemia, hypertension, and depression.Conclusions: The demographic and clinical characteristics of degenerative cervical spine disease in Mexico differ with respect to other geographical regions by a younger age of diagnosis, a high frequency of cardiovascular, metabolic, and mental health comorbidities, and an increased prevalence of concomitant lumbar spinal stenosis.Clinical Relevance: Our findings reveal a considerably high burden of cervicolumbar tandem spinal stenosis as a distinctive feature of Mexican patients with cervical spine degeneration.Level of Evidence: 1.

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Section: Discussionmentioning

confidence: 99%

Demographic and Clinical Characteristics of Patients With Cervical Spine Degeneration Reveal Frequent Cervicolumbar Tandem Spinal Stenosis in Mexico

et al. 2023

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“…In clinical practice, the priority resolution of cervical compression with or without myelopathy is supported (13). Cervical procedures do not only resolve typical CSS symptoms but can also improve lumbar symptoms, including radiculopathy and low back pain (84,85,86,87), which decreases the necessity of subsequent lumbar surgery (26,84). Compared with starting from the lumbar region, initial cervical surgery results in a higher complete resolution rate, lower rates of developing new symptoms and secondary surgery, and longer surgical intervals (11,67,72).…”

Section: Surgical Order Of Cltssmentioning

confidence: 99%

“…Despite the improvement in lumbar symptoms after the cervical procedure, the effect of cervical surgery cannot be overclaimed. Some lumbar symptoms, such as intermittent claudication, cannot be relieved by cervical decompression (2), and most lumbar symptoms were temporarily relieved; only 14% of patients with CLTSS experience improvements in long-term follow-ups, while the rest would need to undergo secondary surgery (87). Sometimes, lumbar surgery alone provides better outcomes than cervical surgery or both procedures in patients with CLTSS who predominantly present with lumbar symptoms (15).…”

Section: Surgical Order Of Cltssmentioning

confidence: 99%

Current understanding of tandem spinal stenosis: epidemiology, diagnosis, and surgical strategy

et al. 2022

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Tandem spinal stenosis (TSS) is defined as the concomitant occurrence of stenosis in at least two or more distinct regions (cervical, thoracic, or lumbar) of the spine and may present with a constellation of signs and symptoms. It has four subtypes, including cervico-lumbar, cervico-thoracic, thoraco-lumbar, and cervico-thoraco-lumbar TSS. The prevalence of TSS varies depending on the different subtypes and cohorts. The main aetiologies of TSS are spinal degenerative changes and heterotopic ossification, and patients with developmental spinal stenosis, ligament ossification, and spinal stenosis at any region are at an increased risk of developing TSS. The diagnosis of TSS is challenging. The clinical presentation of TSS could be complex, concealed, or severe, and these features may be confusing to clinicians, resulting in an incomplete or delayed diagnosis. Additionally, a consolidated diagnostic criterion for TSS is urgently required to improve consistency across studies and form a basis for establishing treatment guidelines. The optimal treatment option for TSS is still under debate; areas of controversies include choice of the decompression range, choice between simultaneous or staged surgical patterns, and the order of the surgeries. The present study reviews publications on TSS, consolidates current awareness on prevalence, aetiologies, potential risk factors, diagnostic dilemmas and criteria, and surgical strategies based on TSS subtypes. This is the first review to include thoracic spinal stenosis as a candidate disorder in TSS and aims at providing the readers with a comprehensive overview of TSS.

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“…We read the article "Primary cervical decompression surgery may improve lumbar symptoms in patients with tandem spinal stenosis" by Inoue T, et al [1] with great interest and had a long deliberation and appraisal on the different aspects discussed in the concerned article. At the go, we congratulate the authors for selecting a retrospective analysis of a common combination of stenosis, but scarcely described in literature.…”

Section: Dear Editormentioning

confidence: 99%

Letter to the editor concerning "primary cervical decompression surgery may improve lumbar symptoms in patients with tandem spinal stenosis" by Inoue T, et al. (Eur Spine J; 2021 jan 6. doi: 10.1007/s00586-020-06,693-0)

et al. 2021

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Primary cervical decompression surgery may improve lumbar symptoms in patients with tandem spinal stenosis

Cited by 11 publications

References 29 publications

Demographic and Clinical Characteristics of Patients With Cervical Spine Degeneration Reveal Frequent Cervicolumbar Tandem Spinal Stenosis in Mexico

Demographic and Clinical Characteristics of Patients With Cervical Spine Degeneration Reveal Frequent Cervicolumbar Tandem Spinal Stenosis in Mexico

Current understanding of tandem spinal stenosis: epidemiology, diagnosis, and surgical strategy

Letter to the editor concerning "primary cervical decompression surgery may improve lumbar symptoms in patients with tandem spinal stenosis" by Inoue T, et al. (Eur Spine J; 2021 jan 6. doi: 10.1007/s00586-020-06,693-0)

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