Comparison of outcomes in simultaneous or staged operation for treatment of tandem spinal stenosis

English Keywords:Tandem spinal stenosis  Simultaneous operation  Staged operation  Clinical outcomes

English Abstract:

  【Abstract】 Objectives: To retrospectively observe different staged operations and simultaneous surgery for patients with tandem spinal stenosis(TSS) and compare the clinical outcomes. The results would provide the evidence for surgical decision-making. Methods: From January 2011 to December 2016, 127 patients with TSS were enrolled in the current study. The average age of patients, including 79 males and 48 females, was 61.7±8.6 years old(range from 46-74 years old). The patients were divided into three groups according to the surgical procedure, including cervical decompression first(group A, n=86), lumbar decompression first(group B, n=28) and simultaneous decompression(group C, n=13). Operation time, amount of bleeding, hospitalization time and the postoperative complications were recorded and compared. Cervical Japanese Orthopaedic Association(JOA), lumbar JOA, neck disability index(NDI) and Oswestry disability index(ODI) scores were used to evaluate the functional status of patients at pre-operation, post-operation and final follow-up. Results: The patients were followed for average of 31.1±5.7 months. In group A, 33 patients did not need a second lumbar surgery(group A1), but 53(61.63%) patients received the second lumbar decompression(group A2) after an average interval of 5.32±2.10 months. In group B, 3 patients did not need a second cervical surgery(group B1), but 25(89.29%) patients received the second cervical decompression(group B2) after an average interval of 3.84±1.75 months. There were significant differences in the reoperation rate and interval time(P=0.006, P=0.002). In each group, the cervical and lumbar JOA scores increased, and the NDI and ODI improved at final follow-up comparing with the preoperative scores. There were no significant difference between the three groups in operation time and the amount of bleeding(P=0.106, P=0.255), but the hospitalization time in simultaneous group was significantly lower(P<0.001). The complications were higher in the simultaneous group, but with no significant difference(P=0.855). Conclusions: These results indicate that TSS can be effectively managed by either surgical intervention, simultaneous, or staged decompressions. The first-stage cervical decompression can significantly lower the need of the second lumbar surgery. Simultaneous operation does not increase operation time and bleeding, however decreases the hospitalization time. The surgical indications should be strictly controlled when simultaneous operation was performed.