Symptomatic Triple-Region Spinal Stenosis: Case Report and Narrative Literature Review
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Published:
Feb 15, 2024
Keywords:
Symptomatic triple-region spinal stenosis, tandem spinal stenosis, cervical, thoracic, and lumbar stenosis
Main Article Content
Abstract
Simultaneous spinal stenosis across all three regions of the spine is an uncommon condition that requires proper clinical and imaging assessment. There are currently no established guidelines for its diagnosis and treatment. The objective of this paper is to describe, based on a case report, the clinical presentation, treatment, and progression of triple stenosis in a patient and compare it with available evidence through a narrative literature review. A 69-year-old woman presented with progressive paraparesis associated with right sciatica and positive signs of upper motor neuron involvement. Imaging confirmed triple stenosis:cervical, thoracic, and lumbar. She underwent thoracic decompression and tumor resection, as well as conservative treatment for cervical and lumbar stenoses, and showed favorable progress one year after surgery. Symptomatic triple-region spinal stenosis is an uncommon condition. Proper clinical and radiological assessments will enable an accurate diagnosis with appropriate and timely intervention.
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How to Cite
Latallade, V., Pereira Duarte, M., Gamsie, S., Kido, G. R., Petracchi , M. G., & Gruenberg , M. F. (2024). Symptomatic Triple-Region Spinal Stenosis: Case Report and Narrative Literature Review. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(1), 64-69. https://doi.org/10.15417/issn.1852-7434.2024.89.1.1862
Section
Case Presentations
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References
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tandem ossification in the cervical and thoracic spine. Arch Orthop Trauma Surg 2012;132(9):1219-26.
https://doi.org/10.1007/s00402-012-1540-5
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17. Schaffer JC, Raudenbush BL, Molinari C, Molinari RW. Symptomatic triple-region spinal stenosis treated with
simultaneous surgery: Case report and review of the literature. Global Spine J 2015;5(6):513-21. https://doi.org/10.1055/s-0035-1566226
18. Jannelli G, Baticam NS, Tizi K, Truffert A, Lascano AM, Tessitore E. Symptomatic tandem spinal stenosis: a
clinical, diagnostic, and surgical challenge. Neurosurg Rev 2020;43(5):1289-95. https://doi.org/10.1007/s10143-019-01154-9
stenosis and its characteristics in a population-based MRI study: The Wakayama Spine Study. Eur Spine J 2017;26(10):2529-35. https://doi.org/10.1007/s00586-017-5072-0
2. Matsumoto M, Okada E, Toyama Y, Fujiwara H, Momoshima S, Takahata T. Tandem age-related lumbar and
cervical intervertebral disc changes in asymptomatic subjects. Eur Spine J 2013;22(4):708-13. https://doi.org/10.1007/s00586-012-2500-z
3. 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):842-9. https://doi.org/10.3171/jns.1987.66.6.0842
4. Mittal S, Ahuja K, Sudhakar PV, Ifthekar S, Yadav G, Sarkar B, et al. Simultaneous decompression of all stenotic
regions versus decompression of only the most symptomatic region in patients with tandem spinal stenosis: a
systematic review and meta-analysis. Eur Spine J 2022;31(3):561-74. https://doi.org/10.1007/s00586-021-07078-7
5. Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for
neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med 2011;34(6):535-46.
https://doi.org/10.1179/204577211X13207446293695
6. Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 1972;95(1):87-100. https://doi.org/10.1093/brain/95.1.87
7. Medical Research Council. Aids to examination of the peripheral nervous system. Memorandum no. 45. London: Her Majesty’s Stationary Office; 1976.
8. Kato S, Oshima Y, Oka H, Chikuda H, Takeshita Y, Miyoshi K, 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. https://doi.org/10.1371/journal.pone.0123022
9. Buerki RA, Horbinski CM, Kruser T, Horowitz PM, James CD, Lukas RV. An overview of meningiomas. Future
Oncol 2018;14(21):2161-77. https://doi.org/10.2217/fon-2018-0006
10. Uehara M, Tsutsumimoto T, Yui M, Ohta H, Ohba H, Misawa H. Single-stage surgery for compressive thoracic
myelopathy associated with compressive cervical myelopathy and/or lumbar spinal canal stenosis. Eur Spine J 2016;25(6):1904-11. https://doi.org/10.1007/s00586-015-4133-5
11. LaBan MM, Green ML. Concurrent (tandem) cervical and lumbar spinal stenosis: a 10-yr review of 54 hospitalized patients. Am J Phys Med Rehabil 2004;83(3):187-90. https://doi.org/10.1097/01.phm.0000113405.48879.45
12. Cheung KM. Commentary on: “Symptomatic Triple-Region Spinal Stenosis Treated with Simultaneous Surgery: Case Report and Review of the Literature”. Global Spine J 2015;5(6):522. https://doi.org/10.1055/s-0035-1566289
13. Bhandutia A, Brown L, Nash A, Bussey I, Shasti M, Koh E, et al. Delayed diagnosis of tandem spinal stenosis: A
retrospective institutional review. Int J Spine Surg 2019;13(3):283-8. https://doi.org/10.14444/6038
14. Epstein NE, Epstein JA, Carras R, Murthy VS, Hyman RA. Coexisting cervical and lumbar spinal stenosis:
diagnosis and management. Neurosurgery 1984;15(4):489-96. https://doi.org/10.1227/00006123-198410000-00003
15. Chen Y, Chen DY, Wang XW, Lu XH, Yang HS, Miao JH. Single-stage combined decompression for patients with
tandem ossification in the cervical and thoracic spine. Arch Orthop Trauma Surg 2012;132(9):1219-26.
https://doi.org/10.1007/s00402-012-1540-5
16. Hu P, Yu M, Liu X, Liu Z, Jiang L, Chen Z. One-staged combined decompression for the patients with cervicothoracic tandem spinal stenosis. Eur Spine J 2017;26(2):374-81. https://doi.org/10.1007/s00586-016-4497-1
17. Schaffer JC, Raudenbush BL, Molinari C, Molinari RW. Symptomatic triple-region spinal stenosis treated with
simultaneous surgery: Case report and review of the literature. Global Spine J 2015;5(6):513-21. https://doi.org/10.1055/s-0035-1566226
18. Jannelli G, Baticam NS, Tizi K, Truffert A, Lascano AM, Tessitore E. Symptomatic tandem spinal stenosis: a
clinical, diagnostic, and surgical challenge. Neurosurg Rev 2020;43(5):1289-95. https://doi.org/10.1007/s10143-019-01154-9