Stenosis of spinal canal could occur at any site along the whole length of spinal canal from neck to lower back. Lumbar canal stenosis, cervical spinal canal stenosis or thoracic spinal canal stenosis can occur and cause compression over spinal cord at respective level. When spinal canal stenosis occurs simultaneously at two are more regions then it is called as Tandem Spinal Stenosis (TSS). Other terminology used for this condition is Multiregional Spinal Stenosis (MRSS). Multiregional spinal stenosis is defined as spinal stenosis occurring concurrently in all three regions of the spine including the cervical, thoracic, and lumbar spinal segments.
Compression of nerve roots due to spinal canal stenosis leads to neurological symptoms. But in tandem stenosis because of compression at two or more different levels, the clinical presentation will be mixture of symptoms of all levels where spinal cord is getting compressed. This situation makes difficult for clinician to evaluate the most symptomatic level and plan the surgical treatment accordingly.
Historically, Tandem Spinal Stenosis describes the clinical scenario of symptomatic cervical and lumbar stenosis. TSS shows clinical triad trial of symptoms of intermittent lower extremity claudication, gait disturbance, and upper and lower motor neuron signs. The reported prevalence of TSS ranges from 7.6% to 60 %. It is more common in females. The unusual presentation of combined upper and lower motor neuron signs and symptoms may promote the underdiagnosis of this condition. Some patients with TSS might be asymptomatic despite stenotic findings on imaging (MRI).
Patients with suspected TSS need to undergo whole spine imaging procedures which include X-Ray of the whole spine and MRI screening of the entire spine with detailed study at the stenotic regions.
Surgeons should maintain a high index of suspicion for TSS in patients diagnosed with Ossified Posterior Longitudinal Ligament (OPLL) and, if a staged surgical decompression approach is utilized, the cervical region should be addressed first.
Dr Bharat Dave and Dr Ajay Krishnan & Team have been treating this type of cases since last 15 years using best available newer technology with very good clinical outcome in patients. The promising results of their surgical treatment were published as scientific research article in international journal which is being well appreciated and followed by other surgeons [Krishnan A, Dave BR, Kambar AK, Ram H. Coexisting lumbar and cervical stenosis (tandem spinal stenosis): an infrequent presentation. Retrospective analysis of single stage surgery (53 cases). Eur Spine J. 2014 Jan; 23(1):64-73].
Once TSS is diagnosed, its treatment is often based on a combination of surgeon and patient-specific variables with mutual discussion and understanding. Elderly patients having multiple pre-existing medical conditions (Hypertension, Diabetes Mellitus, Asthma, Rheumatoid arthritis, etc) habits (smoking , alcohol ) and diagnosed with TSS are prone for high rate of complications during and after the surgical procedure. Patients with TSS benefit more if appropriate treatment is given at right time.
Stavya Spine Hospital and Research Institute Pvt. Ltd. has got all latest instruments required for these high-end surgeries. These surgeries are done under continuous monitoring of the nerves to avoid any further damage to them. These valuable instruments help in better clinical outcome of the patient.
