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European Spine Journal

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Open Access 01-02-2017 | Original Article

One-staged combined decompression for the patients with cervico-thoracic tandem spinal stenosis

Authors: Panpan Hu, Miao Yu, Xiaoguang Liu, Zhongjun Liu, Liang Jiang, Zhongqiang Chen

Published in: European Spine Journal | Issue 2/2017

Abstract

Purpose

To report the techniques and safety of one-staged combined decompression for the patients with tandem spinal stenosis (TSS) at cervical and thoracic spine.

Methods

Sixteen TSS subjects, who received combined decompression from Aug 2005 to Feb 2012, were reviewed. The essentials of our surgical strategy included: choosing patients with TSS from cervical to upper or middle thoracic spine, using one single posterior incision, simplifying surgical maneuvers and performing circumferential decompression for thoracic compression if it was indicated. The Japanese Orthopedic Association (JOA) scale for cervical myelopathy was employed to evaluate the neurological status, and Hirabayashi’s system to assess neurological recovery rate.

Results

The average operation duration, blood loss and postoperative hospitalization were 242.8 ± 89.9 min, 1581.3 ± 1237.2 ml and 11.9 ± 7.5 days, respectively. Six subjects (37.5 %) suffered instant neurological deterioration. Other complications included cerebrospinal fluid leakage (10 subjects, 62.5 %), new radiculopathy (two subjects), urinary infection, lung infection and pulmonary thromboembolism. Four subjects received extra-thoracic decompression due to the remaining anterior compression in one subject and new emerging compression in other three subjects. Eventually, mean JOA score was elevated from 9.8 ± 2.1 to 13.7 ± 2.7 after this procedure, and the neurological recovery of seven subjects was rated as excellent, four as good, two as fair, three as unchanged or deteriorated. The overall recovery rate was 53.7 %.

Conclusion

Combined cervico-thoracic decompression could provide fair neurological outcomes for patients with cervico-thoracic TSS, but it was complicated with high rate of undesirable postoperative events. So, more efforts should be done against its eventful postoperative course before its wide application.

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Dagi TF, Tarkington MA, Leech JJ (1987) Tandem lumbar and cervical spinal stenosis. Natural history, prognostic indices, and results after surgical decompression. J Neurosurg 66(6):842–849CrossRefPubMed

Ghobrial GM, Oppenlander ME, Maulucci CM et al (2014) Management of asymptomatic cervical spinal stenosis in the setting of symptomatic tandem lumbar stenosis: a review. Clin Neurol Neurosurg 124:114–118CrossRefPubMed

Kikuike K, Miyamoto K, Hosoe H et al (2009) One-staged combined cervical and lumbar decompression for patients with tandem spinal stenosis on cervical and lumbar spine: analysis of clinical outcomes with minimum 3 years follow-up. J Spinal Disord Tech 22(8):593–601CrossRefPubMed

Park JY, Chin DK, Kim KS et al (2008) Thoracic ligament ossification in patients with cervical ossification of the posterior longitudinal ligaments: tandem ossification in the cervical and thoracic spine. Spine (Phila Pa 1976) 33(13):E407–E410CrossRef

Chen Y, Chen DY, Wang XW et al (2012) Single-stage combined decompression for patients with tandem ossification in the cervical and thoracic spine. Arch Orthop Trauma Surg 132(9):1219–1226CrossRefPubMed

Krishnan A, Dave BR, Kambar AK et al (2014) Coexisting lumbar and cervical stenosis (tandem spinal stenosis): an infrequent presentation. Retrospective analysis of single-stage surgery (53 cases). Eur Spine J 23(1):64–73CrossRefPubMed

Hu P, Yu M, Liu X et al (2015) A circumferential decompression-based surgical strategy for multilevel ossification of thoracic posterior longitudinal ligament. Spine J 15(12):2484–2492CrossRefPubMed

Yonenobu K, Abumi K, Nagata K et al (2001) Interobserver and intraobserver reliability of the Japanese Orthopaedic Association scoring system for evaluation of cervical compression myelopathy. Spine (Phila Pa 1976) 26(17):1890–1894CrossRef

Guo Q, Ni B, Yang J et al (2011) Simultaneous ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum causing upper thoracic myelopathy in DISH: case report and literature review. Eur Spine J 20(Suppl 2):S195–S201CrossRefPubMed

10.

Eskander MS, Aubin ME, Drew JM et al (2011) Is there a difference between simultaneous or staged decompression for combined cervical and lumbar stenosis? J Spinal Disord Tech 24(6):409–413CrossRefPubMed

11.

Onishi E, Sano H, Matsushita M (2013) Surgical treatment for thoracic myelopathy due to simultaneous ossification of the posterior longitudinal ligament and ligamentum flavum at the same level. J Spinal Disord Tech. doi:10.1097/BSD.0000000000000059

12.

Saetia K, Cho D, Lee S et al (2011) Ossification of the posterior longitudinal ligament: a review. Neurosurg Focus 30(3):E1CrossRefPubMed

13.

Kawahara N, Tomita K, Murakami H et al (2008) Circumspinal decompression with dekyphosis stabilization for thoracic myelopathy due to ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976) 33(1):39–46CrossRef

14.

Yamazaki M, Mochizuki M, Ikeda Y et al (2006) Clinical results of surgery for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: operative indication of posterior decompression with instrumented fusion. Spine (Phila Pa 1976) 31(13):1452–1460CrossRef

15.

Takahata M, Ito M, Abumi K et al (2008) Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament. Spine (Phila Pa 1976) 33(15):1199–1208CrossRef

16.

Hannallah D, Lee J, Khan M et al (2008) Cerebrospinal fluid leaks following cervical spine surgery. J Bone Joint Surg Am 90(5):1101–1105CrossRefPubMed

17.

Li M, Meng H, Du J et al (2012) Management of thoracic myelopathy caused by ossification of the posterior longitudinal ligament combined with ossification of the ligamentum flavum—a retrospective study. Spine J 12(12):1093–1102CrossRefPubMed

18.

Syre P, Bohman LE, Bltuch G (2014) Cerebrospinal fluid leaks and their management after anterior cervical discetomy and fusion: a report of 13 cases and a review of the literature. Spine (Phila Pa 1976) 39(16):E936–E943CrossRef

19.

Chiba K, Ogawa Y, Ishii K et al (2006) Long-term results of expansive open-door laminoplasty for cervical myelopathy-average 14-year follow-up study. Spine (Phila Pa 1976) 31(26):2998–3005CrossRef

Title: One-staged combined decompression for the patients with cervico-thoracic tandem spinal stenosis
Authors: Panpan Hu
Miao Yu
Xiaoguang Liu
Zhongjun Liu
Liang Jiang
Zhongqiang Chen
Publication date: 01-02-2017
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 2/2017
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-016-4497-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

One-staged combined decompression for the patients with cervico-thoracic tandem spinal stenosis

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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