Symptomatic Triple-Region Spinal Stenosis Treated with Simultaneous Surgery: Case Report and Review of the Literature

Schaffer, Joseph Christopher; Raudenbush, Brandon; Molinari, Christine; Molinari, Robert W.

doi:10.1055/s-0035-1566226

Cited by 17 publications

(9 citation statements)

References 19 publications

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“…На основании комплексной оценки анатомических, клинических и инструментальных параметров авторы разработали алгоритм тактики хирургического лечения пациентов с тандем-стенозами шейного и пояснично-крестцового отделов позвоночника, базирующийся на факторах, которые влияют на клинический исход: анамнестических данных (длительности заболевания), особенностях принятой хирургической тактики (первичности отдела позвоночника при вмешательстве, объеме декомпрессии, периоде между этапами операций). При анализе данных современной литературы установлено, что большинство исследований о результатах лечения пациентов с тандем-стенозами позвоночного канала являются ретроспективными [13,17,21,22] или описывают отдельные клинические случаи [12,23,24].…”

Section: Discussionunclassified

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

Бывальцев¹,

Krutko²,

Шепелев³

et al. 2017

Hir. pozvonoč.

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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.

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Section: Discussionunclassified

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

Бывальцев¹,

Krutko²,

Шепелев³

et al. 2017

Hir. pozvonoč.

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“…Recently, treatment with CTLTSS has been reported (95). Some surgeons have applied simultaneous surgery to all lesions and reported improvement without complications (95).…”

Section: Surgical Strategy For Tss With Thssmentioning

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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“…MIOM has been widely used in clinical practice due to its great advantages. [25][26][27] More and more studies have reported that applying MIOM to TSS surgeries can effectively prevent spinal cord injury, and thus lead to better prognosis.…”

Section: Multimodality Intraoperative Monitoring (Miom)mentioning

confidence: 99%

Progress in Intraoperative Neurophysiological Monitoring for the Surgical Treatment of Thoracic Spinal Stenosis

Liu¹,

Zhao²

2017

Chinese Medical Sciences Journal

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Thoracic spinal stenosis (TSS) is a group of clinical syndromes caused by thoracic spinal cord compression, which always results in severe clinical complications. The incidence of TSS is relatively low compared with lumbar spinal stenosis, while the incidence of spinal cord injury during thoracic decompression is relatively high. The reported incidence of neurological deficits after thoracic decompression reached 13.9%. Intraoperative neurophysiological monitoring (IONM) can timely provide information regarding the function status of the spinal cord, and help surgeons with appropriate performance during operation. This article illustrates the theoretical basis of applying IONM in thoracic decompression surgery, and elaborates on the relationship between signal changes in IONM and postoperative neurological function recovery of the spinal cord. It also introduces updated information in multimodality IONM, the factors influencing evoked potentials, and remedial measures to improve the prognosis. should be alert to the existence of false-negative tests during thoracic decompression surgery, and endeavor to achieve timely detection and appropriate treatment. Deteriorated signals and the achievement of the "alarm point" during the operationThe present criterion for an abnormal SEP, namely a 50% decrease in amplitude and/or a 10% increase in latency, has been widely used in the surgical treatment of TSS. 14,16 In the study by Taher Multimodality intraoperative monitoring (MIOM)SEP is a method of monitoring the sensory pathway, and it cannot directly monitor the motor conduction pathway in the anterior column of the spinal cord. This is the basic cause of false-negative SEP monitoring. Factors influencing evoked potentialsThe intraoperative signal changes are mainly caused by factors related to anesthesia, physiology and surgery. If no significant signal recovery after these treatments, Stagnara wake-up test and shock therapy using methylprednisolone are suggested. Shock therapy involves an initial bolus of 30 mg/kg of methylprednisolone followed by an infusion of 5.4 mg/kg/h for 23 hours. 35 Methylprednisolone therapy should be maintained till the end of the surgery.After the surgery, whether to apply the drug continuously or to change to other rehabilitation treatments depends on the recovery status from the postoperative neurological functional evaluation. Summary and prospectsIn summary, the application of IONM during thoracic

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Symptomatic Triple-Region Spinal Stenosis Treated with Simultaneous Surgery: Case Report and Review of the Literature

Cited by 17 publications

References 19 publications

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

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

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

Progress in Intraoperative Neurophysiological Monitoring for the Surgical Treatment of Thoracic Spinal Stenosis

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