Results of Staged Surgical Treatment of Patients With Tandem Stenosis of the Cervical and Lumbosacral Spine

Abstract

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.

Efficacy of the Clinical-Instrumental Algorithm in the Treatment of Spinal Tandem Stenosis

“…The algorithm involves factors affecting the clinical outcome: medical history (disease duration), and features of the chosen surgical tactics (the spinal region to be operated first, the volume of decompression, and the time interval between surgical stages). 22 According to the ODI and NDI scores, changes in postoperative pain intensity and functional state of patients in the study group did not significantly differ from the published data on surgical treatment of isolated stenoses of the spinal canal. 1,3,13 Comparative analysis of retrospective group revealed the best clinical outcomes (according to the VAS, ODI, NDI, and the Macnab and Nurick scales) in the long-term period, which confirmed the efficacy of the developed differential surgical tactics for treating patients with tandem stenoses of the cervical and lumbar spine.…”

“…A direct correlation was revealed between unfavorable long-term clinical outcomes and the primary operative intervention on the lumbar spine, the time interval between the stages of surgical interventions, the severity of intracanal scarring, and the development of pseudoarthrosis in the operated segments. 22 In order to optimize surgical outcomes and eliminate potential adverse effects, assessed retrospectively, we proposed a surgical tactic based on a differential clinical-instrumental algorithm for treating patients with symptomatic tandem stenosis of the cervical and lumbar spine. This study is devoted to analyzing the efficacy of the proposed therapeutic-diagnostic tactics.…”

Complications of Surgical Treatment of Lumbar Stenosis in the Early Postoperative Period

“…Lumbar stenosis of degenerative etiology is one of the most common causes of progressive functional deadaptation of the spine. According to the literature, [1][2][3][4][5][6] lumbar stenosis occurs in 6 to15% of patients with chronic back pain. The averaged number of annual operations for lumbar stenosis in Western Europe is 114-132 per 1,000,000 people.…”

“…The averaged number of annual operations for lumbar stenosis in Western Europe is 114-132 per 1,000,000 people. 4 There are various surgical approaches aimed at eliminating degenerative spinal stenosis, but the choice of technique is still a matter of debate. 3,5 Dorsal root decompression in combination with transpedicular fixation and interbody spondylodesis, performed via posterior or posterolateral access to the intervertebral discs (PLIF or TLIF), has recently become widespread.…”

Multicenter Analysis of Surgical Treatment Effectiveness for Patients With Symptomatic Tandem Stenosis of the Cervical and Lumbar Spine Based on Differentiated Clinical-Instrumental Algorithm

“…нами ранее было проведено детализированное исследование неудовлетворительных результатов ретроспективно диагностированных тандем-стенозов позвоночного канала. его результаты выявили прямую корреляционную зависимость неблагоприятного отдаленного клинического исхода с выполнением первичного оперативного вмешательства на поясничном отделе позвоночника, длительностью временного промежутка между этапами оперативных вмешательств, выраженностью рубцово-спаечных интраканальных изменений и развитием псевдоартроза в оперированных сегментах [22]. с целью оптимизации хирургических исходов и ликвидации возможных неблагоприятных последствий, оцененных ретроспективно, нами предложена хирургическая тактика лечения пациентов с симптоматичным тандем-стенозом шейного и поясничного отделов позвоночника на основе дифференцированного клинико-инструментального алгоритма.…”