BACKGROUND CONTEXT

Tandem spinal stenosis (TSS) refers to a narrowing of the spinal canal in distinct, noncontiguous regions. TSS most commonly occurs in the cervical and lumbar regions. Decompressive surgery is indicated for those with cervical myelopathy or persistent symptoms from lumbar stenosis despite conservative management. Surgical management typically involves staged procedures, with cervical decompression taking precedence in most cases, followed by lumbar decompression at a later time. However, several studies have shown favorable outcomes in simultaneous decompression.

PURPOSE

The aim of this study is to provide a literature review and compare surgical outcomes in patients undergoing staged vs simultaneous surgery for TSS.

STUDY DESIGN/SETTING

Systematic literature review.

METHODS

A systematic review using PRISMA guidelines to identify original research articles for tandem spinal stenosis. PubMed, Cochrane, Ovid, Scopus, and Web of Science were used for electronic literature search. Original articles from 2005 to 2021 with more than eight adult patients treated surgically for cervical and lumbar TSS in staged or simultaneous procedures were included. Articles including pediatric patients, primarily thoracic stenosis, stenosis secondary to neoplasm or infectious disease, minimally invasive surgery, and non-English language were excluded. Demographic, perioperative, complications, functional outcome, and neurologic outcome data including mJOA (modified Japanese Orthopaedic Association), Nurick grade (NG), and ODI (Oswestry disability index), were extracted and summarized.

RESULTS

A total of 667 articles were initially identified. After preliminary screening, 21 articles underwent full-text screening. Ten articles met our inclusion criteria. A total of 831 patients were included, 571 (68%) of them underwent staged procedures, and 260 (32%) underwent simultaneous procedures for TSS. Mean follow-ups ranged from 12 to 85 months. There was no difference in estimated blood loss (EBL) between staged and simultaneous groups (p=.639). Simultaneous surgeries had shorter surgical time than staged surgeries (p<.001). Mean changes in mJOA, NG, and ODI was comparable between staged and simultaneous groups. Complications were similar between the groups. There were more major complications reported in simultaneous operations, although this was not statistically significant (p=.301).

CONCLUSION

Staged and simultaneous surgery for TSS have comparable perioperative, functional, and neurologic outcomes, as well as complication rates. Careful selection of candidates for simultaneous surgery may reduce the length of stay and consolidate rehabilitation, thereby reducing hospital-associated costs.

中文翻译：

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串联椎管狭窄手术治疗的结果：系统文献回顾

背景语境

串联椎管狭窄 (TSS) 是指椎管在不同的、不连续的区域变窄。TSS最常发生在颈椎和腰椎区域。尽管进行了保守治疗，但仍存在脊髓型颈椎病或腰椎管狭窄症状持续存在的患者需要进行减压手术。手术治疗通常涉及分阶段手术，在大多数情况下优先进行颈椎减压，然后再进行腰椎减压。然而，一些研究表明同时减压具有良好的效果。

目的

本研究的目的是提供文献综述并比较接受分期手术与同步手术治疗 TSS 的患者的手术结果。

研究设计/设置

系统的文献综述。

方法

使用 PRISMA 指南的系统评价，以确定串联椎管狭窄的原始研究文章。PubMed、Cochrane、Ovid、Scopus 和 Web of Science 用于电子文献检索。纳入了 2005 年至 2021 年的原创文章，其中超过 8 名成年患者在分期或同步手术中接受了颈椎和腰椎 TSS 手术治疗。包括儿科患者、主要是胸椎狭窄、继发于肿瘤或传染病的狭窄、微创手术和非英语的文章被排除在外。提取和总结了人口统计学、围手术期、并发症、功能结果和神经系统结果数据，包括 mJOA（改良的日本骨科协会）、Nurick 分级 (NG) 和 ODI（Oswestry 残疾指数）。

结果

初步确定了 667 篇文章。经初步筛选，对21篇文章进行全文筛选。十篇文章符合我们的纳入标准。共纳入 831 名患者，其中 571 名 (68%) 接受了分期手术，260 名 (32%) 接受了 TSS 同步手术。平均随访时间为 12 至 85 个月。分期组和同时组的估计失血量 (EBL) 没有差异 (p=.639)。同时手术的手术时间比分期手术短 (p<.001)。mJOA、NG 和 ODI 的平均变化在阶段组和同步组之间具有可比性。两组之间的并发症相似。在同时进行的手术中报告了更多的主要并发症，尽管这在统计学上并不显着 (p=.301)。

结论

TSS 的分期和同时手术具有可比的围手术期、功能和神经系统结果，以及并发症发生率。仔细选择同步手术的候选人可能会缩短住院时间并巩固康复，从而降低医院相关费用。