Diagnosis, Management, and Clinical Outcomes of Tandem Thoracic and Lumbar Stenosis: A Systematic Literature Review and Case Series.

Autor: Ronald AA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA., Kaushal M; Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Ems R; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA., Labak C; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center., Wright J; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center., Wright CH; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center. Electronic address: Christina.wright@uhhospitals.org., Sajatovic M; Department of Neurology, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Department of Psychiatry, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA., Kasliwal MK; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2020 Nov; Vol. 143, pp. 546-552.e1. Date of Electronic Publication: 2020 Jun 08.
DOI: 10.1016/j.wneu.2020.06.021
Abstrakt: Background: A scarcity of data has been reported on tandem thoracic lumbar stenosis, which might be related to either the rarity or underdiagnosis of the condition. We have presented a systematic review of the clinical presentation, diagnosis, and treatment patterns for patients with symptomatic tandem thoracic and lumbar stenosis.
Methods: A PubMed/MEDLINE search was performed to find reports of patients with symptomatic tandem thoracic and lumbar stenosis.
Results: The review identified 10 studies with a total of 48 patients with tandem thoracic and lumbar stenosis. Most patients (n = 41; 85%) had had tandem stenosis diagnosed at the initial investigation, with 71% of the reports citing ossification of the ligamentum flavum as a contributing etiology. A few patients (n = 7; 15%) had had thoracic lesions diagnosed after neurologic deterioration that had occurred after lumbar surgery for previously suspected isolated lumbar stenosis. Surgical management varied from isolated thoracic decompression, staged decompression, and simultaneous decompression. Most patients (n = 41; 87%) showed improved neurologic status after surgery.
Conclusion: Ossification of the ligamentum flavum might play a key role in the pathogenesis of the condition. Most patients with tandem thoracic and lumbar stenosis will show improvement after surgical decompression. Although the limited evidence available has raised concerns regarding neurologic deterioration after initial lumbar decompression in patients with coexisting thoracic stenosis, the data are insufficient to definitively determine an optimal surgical strategy. Further research is needed to identify the optimal diagnostic and management criteria for patients with symptomatic tandem thoracic and lumbar stenosis.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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