Simultaneous Cervical and Lumbar Spine Surgery: Retrospective Analysis of 45 Cases

Abstract

Background The term ‘tandem spinal stenosis’ (TSS) was first introduced by Dagi et al to describe concurrent symptomatic cervical and lumbar spinal stenosis. A typical clinical picture includes intermittent neurogenic claudication, myelopathy, and polyradiculopathy in both the upper and lower extremities. The incidence of TSS ranges from 0.12 to 28%. Methods We studied patients who presented with tandem canal stenosis and operated cervicolumbar decompression with or without fusion procedures by two separate neurosurgical teams simultaneously from June 2015 to 2017 with follow-up period of minimum 6 months. Results We had 30 (66.66%) male and 15 (33.33%) female patients who underwent simultaneous cervical and lumbar spine surgeries. The average age was 57.8 years (male) and 53.9 years (female). Cervical canal stenosis was graded as per magnetic resonance imaging (MRI) morphological grades of stenosis by Kang et al and lumbar grading, was done as per Schizas et al grading system. The mean duration of complaints in cervical and lumbar compression was 29.54 ± 44.99 months and 30.55 ± 38.11 months, respectively. The mean preoperative Japanese Orthopaedic Association (JOA) score of was 10.46 ± 1.39, whereas the postoperative mean JOA score was 11.93 ± 1.28, and mean preoperative (38.59 ± 16.52) and postoperative (29.22 ± 9.38) Oswestry Disability Index (ODI) scores showed a statistically significant difference (p = 0.0001). Conclusion Patients with TSS are elderly and have associated comorbidities, still simultaneous cervical and lumbar surgery is feasible with the good outcome if you have two neurosurgical teams operating simultaneously and having good other super specialty teams’ support. It can be timesaving and cost effective for patients. Also, it avoids patients from undergoing exposure to two separate surgical and anesthetic stress.

Tandem Spinal Stenosis at the Brazzaville Academic Hospital

“…The average duration of signs was 17.6 months in our series. It was 29.54±44.99 months for the cervical spine and 30.55±38 months for the lumbar spine at Aiwale [9]. The concerned clinical signs were a function of the spinal segments.…”

“…The average age of our patients was 57 years, and male subjects predominated. Aiwale noted a male predominance (66.6%) and an average age of 57.8 years for men and 53.9 years for women [9]. Keiji Nagata also found a male predominance of 66.6% [10].…”

“…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 number of affected level ranged from one (especially in the cervical and lumbar) to five (only one case found at the thoracic level). For Aiwale [9], this number varied according to the spinal segment concerned. He noted a predominance of unique location in the lumbar area and more than three in the cervical one.…”