RESUMEN
STUDY DESIGN: Retrospective study. OBJECTIVE: To evaluate and compare the outcomes of single stage surgery for Tandem Spinal Stenosis (TSS) in elderly (Age ≥65 years) and younger patients (Age <65 years). SUMMARY OF BACKGROUND DATA: Tandem spinal stenosis among elderly is common and often missed diagnosed with delayed presentation. Literature evaluating efficacy and safety of single staged surgery for TSS in elderly patients is scanty. METHODS: Analysis of 74 patients with TSS managed with single stage posterior surgery from 2007 to 2016 was done. A total of 62 patients who satisfied our inclusion criteria were evaluated and subdivided into two groups based on age; Study group (age ≥65years)] (n = 32) and control group (age <65years) (n = 30). Perioperative, clinical/radiological parameters and postoperative complications and recovery rate were noted. RESULTS: The Mean ODI and mJOA showed significant improvement post-operatively in both groups however there was no significant difference between the two groups at final follow-up. There was no statistical difference in operative time, blood loss and hospital stay between the groups. As per Odom's criteria, 78.1% had excellent to good results in study group, while 83.3% had excellent to good results in control group. Postoperative complications were more in elderly group however, there was no significant difference among neurological or cardiopulmonary complications between both groups. CONCLUSIONS: Single stage surgery is safe & efficacious modality with less morbidity and optimal results in elderly patients with proper preoperative risk assessment. Our study showed that increased age does not proved to be deterrent in the outcome of single staged surgery in tandem spinal stenosis.
RESUMEN
There have been a few reports of patients with a combination of lumbar and thoracic spinal stenosis. We describe six patients who suffered unexpected acute neurological deterioration at a mean of 7.8 days (6 to 10) after lumbar decompressive surgery. Five had progressive weakness and one had recurrent pain in the lower limbs. There was incomplete recovery following subsequent thoracic decompressive surgery. The neurological presentation can be confusing. Patients with compressive myelopathy due to lower thoracic lesions, especially epiconus lesions (T10 to T12/L1 disc level), present with similar symptoms to those with lumbar radiculopathy or cauda equina lesions. Despite the rarity of this condition we advise that patients who undergo lumbar decompressive surgery for stenosis should have sagittal whole spine MRI studies pre-operatively to exclude proximal neurological compression.