Surgical outcomes for lumbar spinal canal stenosis with coexisting cervical stenosis (tandem spinal stenosis): a retrospective analysis of 565 cases

Background: Concurrent cervical and lumbar spinal canal stenosis is known as tandem spinal stenosis (TSS). As research on TSS is limited, there is no consensus on the optimal surgical approach to this problem. We evaluated the prevalence and clinical characteristics of TSS in patients with symptomatic lumbar spinal canal stenosis (LCS). Methods: The authors performed a retrospective analysis of the outcomes of 565 patients who underwent lumbar surgeries performed for symptomatic LCS. In all the patients, both the cervical and lumbar regions were evaluated preoperatively, and we compared TSS patients and non-TSS patients in terms of multiple clinical parameters. In the TSS patients, we investigated the ratio and clinical outcomes of additional cervical surgeries performed on TSS patients. Results: Two hundred two cases (35.8%) were considered to be TSS. Twenty-eight patients (5.0%) underwent a cervical operation during the follow-up period. There were no differences between the radiographic TSS patients and non-TSS patients in terms of preoperative lumbar-Japanese Orthopedic Association (L-JOA) scores, postoperative L-JOA scores, and the L-JOA recovery rate (14.8 +/- 4.4 points vs 14.2 +/- 4.6 points, 23.9 +/- 4.3 points vs 23.1 +/- 4.5 points, 63.7 +/- 28.2% vs 60.3 +/- 27.9%, respectively), while the TSS group included a greater number of hypertension cases. The recovery rate L-JOA scores of patients who underwent additional cervical surgeries were significantly lower compared with the rate of patients who experienced treatment for only lumbar lesions (62.8 +/- 25.8% vs 39.8 +/- 35.5%, p = 0.0003). However, additional cervical surgery still improved both the cervical myelopathy-Japanese Orthopedic Association (C-JOA) and L-JOA scores in TSS patients with symptomatic cervical lesion (from 10.3 +/- 2.8 points to 12.1 +/- 3.0 points, p = 0.0302; from 14.8 +/- 7.3 points to 19.9 +/- 5.0 points, p = 0.0331, respectively). In these patients, there were no significant differences in the recovery rate of both C-JOA and L-JOA scores between the single-stage surgery group and the staged surgery group (40.7 +/- 35.8% vs 20.7 +/- 16.1%; 50.9 +/- 25.1% vs 34.2 +/- 39.3%, respectively). Conclusions: Radiographic co-existing cervical stenosis did not affect surgical outcomes for LCS, although symptomatic cervical lesion affected neurological score after lumbar surgery. An additional surgery for cervical lesion significantly improved neurological findings in TSS patients.