Abstract: Background: Tandem stenosis at cervical and lumbar area of spine is not uncommon in degenerative spine disease in elderly above 60 years. Both of these pathologies may progress independently at each level and severity of stenosis at each level may vary. In early stages cervical stenosis may present as leg tiredness on exertion, early fatigue on standing, night cramps, occasional neck pain but often low back pain, without any neurological signs but sometimes only brisk reflexes which can be overlooked and these symptoms may be considered as claudication. As patient present mostly with lower limb symptoms we try to concentrate mostly in lumbo-Sacral area until there was no evident myelopathy in cervical spine in MRI findings or sign of upper motor neuron like clonus, stiffness, unsteady gait are present clinically. Decompression at both level in single setting is preferred treatment in tandem stenosis but is this aggressive approach really needed or not? Because it may lead to morbidity and mortality in elderly patients. Here we will going to assess whether cervical cord decompression alone will relieve mild to moderate lumbar stenotic symptoms indirectly, as natural history of degenerative lumbar spine disease seems to be favorable in patients who were managed conservatively.
Objective: To determine whether decompression of cervical cord leads to improvement in lower limb symptoms that can prevent or delay other level surgery mostly lumbar spine which may be unnecessary.
Material and methods: We retrospectively analyzed data of 19 patient who were diagnosed as tandem stenosis at cervical and lumbar region but undergone only cervical decompression either in the form of Anterior or posterior surgery or both in last 2 year with at least 1 year of fallow up. Patient with lumbar spine instability, associated old or fresh fracture of thoracic and lumbar area, pain originated from infective or tumor pathology were excluded. All 19 patients were assessed with pre-operative and post-operative VAS scores for pain, mJOA score for cervical symptoms, modified ODI score for lower limb symptoms. Preoperatively grading for severity of stenosis at cervical and lumbar levels was done by takahashi et al. grading technique depending on MRI findings. Statistical analysis of results were done using paired T test and p value < 0.05 considered to be statistically significant.
Results: Out of the 19 patients 47% patients had mild lumbar stenosis with moderate cervical stenosis got good symptomatic relief and improved their walking ability near normal. Even though 52% of patient had moderate to severe lumbar canal stenosis of which 89% patient happy with their improved walking ability while 10% of those with persistent lower limb symptoms and sever lumbar stenosis need lumbar decompression surgery later. For VAS the value of t is-17.298154. The value of p is < 0.00001. The result is significant at p< 0.05.For mJOA score the value of t is 8.720665. The value of p is < 0.00001. The result is significant at p< 0.05.For DOI The value of t is -13.191388. The value of p is < 0.00001. The result is significant at p< 0.05.
