Comparative analysis of clinical efficacy and safety of one-stage and staged operations in the treatment of tandem spinal stenosis_West China Medical Journal

Authors：

YANG Sheng , LUO Ning , TANG Chao , LIAO Yehui , TANG Qiang , MA Fei , HE Hongchun , WANG Qing ,  ZHONG Dejun

Department of Spine Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding?author：

ZHONG Dejun, Email: zdj_1974@163.com

Keywords：

Tandem spinal stenosis; Cervical and lumbar vertebral canal decompression; One-stage operation; Staged operation; Clinical efficacy

DOI：

10.7507/1002-0179.201910133

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Objective To analyze and compare the clinical efficacy and safety between one-stage operation and staged operation in the treatment of tandem spinal stenosis (TSS).Methods The data of 39 patients with TSS were retrospectively analyzed, who were definitely diagnosed and treated surgically between February 2011 and March 2016 in the Affiliated Hospital of Southwest Medical University. According to whether one-stage decompression was performed, the patients were divided into group A (cervical and lumbar vertebral canal decompression procedures were performed in one stage, n=21) and group B (cervical and lumbar spinal canal decompression procedures were performed in two stages with a time interval of 3-6 months, n=18). Both one-stage and staged operations were performed by the same surgical team. The Nurick scores, Japanese Orthopedic Association (JOA) scores of cervical spine and lumbar spine, and Oswestry Disability Index (ODI) before operation and in postoperative follow-up, postoperative JOA improvement rate, and perioperative indicators were recorded and compared.Results All patients completed the operations successfully, and the lengths of follow-up were all longer than 12 months. There was no significant difference in gender, age, body mass index, preoperative duration of symptoms, preoperative Kang grade, preoperative Schizas grade, preoperative underlying diseases, preoperative cervical or lumbar spine JOA score, preoperative ODI, preoperative Nurick score, decompression segment or distribution, or length of follow-up between the two groups (P>0.05). The Nurick score, JOA score of cervical and lumbar spine, and ODI at one year after operation and the last follow-up were significantly improved compared with those before operation. The one-year after operation improvement rates of JOA of cervical and lumbar spine in group A were significantly higher than those in group B [cervical spine: (70.55±9.28)% vs. (55.29±7.82)%, P<0.05; lumbar spine: (69.50±4.95)% vs. (51.58±7.62)%, P<0.05], but there was no significant difference in the improvement rate of JOA between the two groups at the last follow-up (P>0.05). There was no significant difference in Nurick score or ODI between the two groups at one year after operation or the last follow-up (P>0.05). There was no significant difference in the average length of hospital stay between the two groups [(15.67±3.40) vs. (15.72±1.57) d, P>0.05]. The operation time [(293.10±43.83) vs. (244.44±22.29) min] and intraoperative bleeding [(533.33±180.51) vs. (380.56±38.88) mL] in group A were significantly higher than those in group B (P<0.05). The incidence of postoperative complications of group A was higher than that of group B (57.1% vs. 16.7%, P<0.05).Conclusions Compared with staged surgery, one-stage operation in the treatment of TSS has a significant improvement in neurological function and clinical efficacy in short-term follow-up, but there is no significant difference in long-term follow-up. Staged surgery has the advantages of shorter operation time, less intraoperative blood loss, lower postoperative complication rate, and higher safety.

Citation： YANG Sheng, LUO Ning, TANG Chao, LIAO Yehui, TANG Qiang, MA Fei, HE Hongchun, WANG Qing, ZHONG Dejun. Comparative analysis of clinical efficacy and safety of one-stage and staged operations in the treatment of tandem spinal stenosis. West China Medical Journal, 2020, 35(3): 328-335. doi: 10.7507/1002-0179.201910133 Copy

1.	Matsumoto M, Okada E, Toyama Y, et al. Tandem age-related lumbar and cervical intervertebral disc changes in asymptomatic subjects. Eur Spine J, 2013, 22(4): 708-713.
2.	Bajwa NS, Toy JO, Young EY, et al. Is congenital bony stenosis of the cervical spine associated with lumbar spine stenosis? An anatomical study of 1 072 human cadaveric specimens. J Neurosurg Spine, 2012, 26(17): 24-29.
3.	Nagata K, Yoshimura N, Hashizume H, et al. The prevalence of tandem spinal stenosis and its characteristics in a population-based MRI study: the Wakayama Spine Study. Eur Spine J, 2017, 26(10): 2529-2535.
4.	Dagi TF, Tarkington MA, Leech JJ. Tandem lumbar and cervical spinal stenosis. Natural history, prognostic indices, and results after surgical decompression. J Neurosurg, 1987, 66(6): 842-849.
5.	Krishnan A, Dave BR, Kambar AK, et al. Coexisting lumbar and cervical stenosis (tandem spinal stenosis): an infrequent presentation. Retrospective analysis of single-stage surgery (53 cases). Eur Spine J, 2014, 23(1): 64-73.
6.	雷濤, 高顯達, 申勇. 頸腰綜合征診斷及外科治療的研究進展. 中華解剖與臨床雜志, 2019, 24(6): 622-626.
7.	Naderi S, Mertol T. Simultaneous cervical and lumbar surgery for combined symptomatic cervical and lumbar spinal stenoses. J Spinal Disord Tech, 2002, 15(3): 229-231.
8.	Kang Y, Lee JW, Koh YH, et al. New MRI grading system for the cervical canal stenosis. AJR Am J Roentgenol, 2011, 197(1): W134-W140.
9.	Schizas C, Theumann N, Burn A, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976), 2010, 35(21): 1919-1924.
10.	胡繼平, 樊宇平, 車鳳義, 等. 頸腰綜合征的臨床治療分析. 頸腰痛雜志, 2009, 30(1): 37-38.
11.	Revanappa KK, Rajshekhar V. Comparison of Nurick grading system and modified Japanese Orthopaedic Association scoring system in evaluation of patients with cervical spondylotic myelopathy. Eur Spine J, 2011, 20(9): 1545-1551.
12.	Kato S, Oshima Y, Oka H, et al. Comparison of the Japanese Orthopaedic Association (JOA) Score and Modified JOA (mJOA) score for the assessment of cervical myelopathy: a multicenter observational study. PLoS One, 2015, 10(4): e0123022.
13.	Lee CP, Fu TS, Liu CY, et al. Psychometric evaluation of the Oswestry Disability Index in patients with chronic low back pain: factor and Mokken analyses. Health Qual Life Outcomes, 2017, 15(1): 192.
14.	雷濤, 高顯達, 曹俊明, 等. 同期或分期手術治療頸腰綜合征的療效觀察與比較. 中國脊柱脊髓雜志, 2019, 29(11): 969-976.
15.	Laban MM, Green ML. Concurrent (tandem) cervical and lumbar spinal stenosis: a 10-yr review of 54 hospitalized patients. Am J Phys Med Rehab, 2004, 83(3): 187-190.
16.	Rahmanian A, Minagar S, Rakei S, et al. A survey of tandem spinal stenosis in Shiraz, Southern Iran. Neurosurg Q, 2015, 25(2): 246-249.
17.	石海浪, 王歡, 崔少千, 等. 頸腰綜合征及其手術治療. 中國矯形外科雜志, 2017, 2(1): 53-57.
18.	Lee MJ, Garcia R, Cassinelli EH, et al. Tandem stenosis: a cadaveric study in osseous morphology. Spine J, 2008, 8(6): 1003-1006.
19.	Park HJ, Kim SS, Chung EC, et al. Clinical correlation of a new practical MRI method for assessing cervical spinal canal compression. AJR Am J Roentgenol, 2012, 199(2): W197-W201.
20.	鐘德君, 康敏, 王清, 等. 全脊柱 MRI 在脊柱外傷診治中的價值. 中國矯形外科雜志, 2009, 17(14): 1100-1102.
21.	潘亞林. 神經電生理檢查在頸腰綜合征治療中的作用. 中華實用診斷與治療雜志, 2011, 25(9): 929-930.
22.	Richter M, Kluger P, Puhl W. Diagnosis and therapy of spinal stenosis in the elderly. Zeitschrift Für Orthop?die Und Ihre Grenzgebiete, 1999, 137(6): 474.
23.	Luo CA, Kaliya-Perumal AK, Lu ML, et al. Staged surgery for tandem cervical and lumbar spinal stenosis: which should be treated first?. Eur Spine J, 2019, 28(1): 61-68.
24.	Eskander MS, Aubin ME, Drew JM, et al. Is there a difference between simultaneous or staged decompressions for combined cervical and lumbar stenosis?. J Spinal Disord Tech, 2011, 24(6): 409-413.
25.	Fager CA. Results of adequate posterior decompression in the relief of spondylotic cervical myelopathy. J Neurosurg, 1973, 38(6): 684-692.

1. Matsumoto M, Okada E, Toyama Y, et al. Tandem age-related lumbar and cervical intervertebral disc changes in asymptomatic subjects. Eur Spine J, 2013, 22(4): 708-713.
2. Bajwa NS, Toy JO, Young EY, et al. Is congenital bony stenosis of the cervical spine associated with lumbar spine stenosis? An anatomical study of 1 072 human cadaveric specimens. J Neurosurg Spine, 2012, 26(17): 24-29.
3. Nagata K, Yoshimura N, Hashizume H, et al. The prevalence of tandem spinal stenosis and its characteristics in a population-based MRI study: the Wakayama Spine Study. Eur Spine J, 2017, 26(10): 2529-2535.
4. Dagi TF, Tarkington MA, Leech JJ. Tandem lumbar and cervical spinal stenosis. Natural history, prognostic indices, and results after surgical decompression. J Neurosurg, 1987, 66(6): 842-849.
5. Krishnan A, Dave BR, Kambar AK, et al. Coexisting lumbar and cervical stenosis (tandem spinal stenosis): an infrequent presentation. Retrospective analysis of single-stage surgery (53 cases). Eur Spine J, 2014, 23(1): 64-73.
6. 雷濤, 高顯達, 申勇. 頸腰綜合征診斷及外科治療的研究進展. 中華解剖與臨床雜志, 2019, 24(6): 622-626.
7. Naderi S, Mertol T. Simultaneous cervical and lumbar surgery for combined symptomatic cervical and lumbar spinal stenoses. J Spinal Disord Tech, 2002, 15(3): 229-231.
8. Kang Y, Lee JW, Koh YH, et al. New MRI grading system for the cervical canal stenosis. AJR Am J Roentgenol, 2011, 197(1): W134-W140.
9. Schizas C, Theumann N, Burn A, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976), 2010, 35(21): 1919-1924.
10. 胡繼平, 樊宇平, 車鳳義, 等. 頸腰綜合征的臨床治療分析. 頸腰痛雜志, 2009, 30(1): 37-38.
11. Revanappa KK, Rajshekhar V. Comparison of Nurick grading system and modified Japanese Orthopaedic Association scoring system in evaluation of patients with cervical spondylotic myelopathy. Eur Spine J, 2011, 20(9): 1545-1551.
12. Kato S, Oshima Y, Oka H, et al. Comparison of the Japanese Orthopaedic Association (JOA) Score and Modified JOA (mJOA) score for the assessment of cervical myelopathy: a multicenter observational study. PLoS One, 2015, 10(4): e0123022.
13. Lee CP, Fu TS, Liu CY, et al. Psychometric evaluation of the Oswestry Disability Index in patients with chronic low back pain: factor and Mokken analyses. Health Qual Life Outcomes, 2017, 15(1): 192.
14. 雷濤, 高顯達, 曹俊明, 等. 同期或分期手術治療頸腰綜合征的療效觀察與比較. 中國脊柱脊髓雜志, 2019, 29(11): 969-976.
15. Laban MM, Green ML. Concurrent (tandem) cervical and lumbar spinal stenosis: a 10-yr review of 54 hospitalized patients. Am J Phys Med Rehab, 2004, 83(3): 187-190.
16. Rahmanian A, Minagar S, Rakei S, et al. A survey of tandem spinal stenosis in Shiraz, Southern Iran. Neurosurg Q, 2015, 25(2): 246-249.
17. 石海浪, 王歡, 崔少千, 等. 頸腰綜合征及其手術治療. 中國矯形外科雜志, 2017, 2(1): 53-57.
18. Lee MJ, Garcia R, Cassinelli EH, et al. Tandem stenosis: a cadaveric study in osseous morphology. Spine J, 2008, 8(6): 1003-1006.
19. Park HJ, Kim SS, Chung EC, et al. Clinical correlation of a new practical MRI method for assessing cervical spinal canal compression. AJR Am J Roentgenol, 2012, 199(2): W197-W201.
20. 鐘德君, 康敏, 王清, 等. 全脊柱 MRI 在脊柱外傷診治中的價值. 中國矯形外科雜志, 2009, 17(14): 1100-1102.
21. 潘亞林. 神經電生理檢查在頸腰綜合征治療中的作用. 中華實用診斷與治療雜志, 2011, 25(9): 929-930.
22. Richter M, Kluger P, Puhl W. Diagnosis and therapy of spinal stenosis in the elderly. Zeitschrift Für Orthop?die Und Ihre Grenzgebiete, 1999, 137(6): 474.
23. Luo CA, Kaliya-Perumal AK, Lu ML, et al. Staged surgery for tandem cervical and lumbar spinal stenosis: which should be treated first?. Eur Spine J, 2019, 28(1): 61-68.
24. Eskander MS, Aubin ME, Drew JM, et al. Is there a difference between simultaneous or staged decompressions for combined cervical and lumbar stenosis?. J Spinal Disord Tech, 2011, 24(6): 409-413.
25. Fager CA. Results of adequate posterior decompression in the relief of spondylotic cervical myelopathy. J Neurosurg, 1973, 38(6): 684-692.

West China Medical Journal

Comparative analysis of clinical efficacy and safety of one-stage and staged operations in the treatment of tandem spinal stenosis

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