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. 2019 Jun 30;13(3):283-288.
doi: 10.14444/6038. eCollection 2019 Jun.

Delayed Diagnosis of Tandem Spinal Stenosis: A Retrospective Institutional Review

Amit Bhandutia  1 , Luke Brown  1 , Alysa Nash  1 , Ian Bussey  1 , Mark Shasti  1 , Eugene Koh  1 , Kelley Banagan  1 , Steven Ludwig  1 , Daniel Gelb  1
Affiliations

Delayed Diagnosis of Tandem Spinal Stenosis: A Retrospective Institutional Review

Amit Bhandutia et al. Int J Spine Surg. .

Abstract

Background: Tandem spinal stenosis (TSS) is defined as simultaneous spinal stenosis in the cervical, thoracic, and/or lumbar regions and may present with both upper and lower motor neuron symptoms, neurogenic claudication, and gait disturbance. Current literature has focused mainly on the prevalence of TSS and treatment methods, while the incidence of delayed TSS diagnosis is not well defined. The purpose of this study was to determine the incidence of delayed TSS diagnosis at our institution and describe the clinical characteristics commonly observed in their particular presentation.

Methods: Following institutional review board approval, an institutional billing database review was performed for patients who underwent a spinal decompression procedure between 2006 and 2016. Thirty-three patients who underwent decompression on 2 separate spinal regions within 1 year were included for review. Patients with delayed diagnosis of TSS following the first surgery were differentiated from those with preoperative diagnosis of TSS.

Results: TSS requiring surgical decompression occurred in 33 patients, with the incidence being 2.06% in this cohort. Fifteen patients received a delayed diagnosis after the first surgical decompression (45%) and were found to have a longer interval between decompressions (7.6 ± 2.1 months versus 4.01 ± 3 months, P = .0004). Patients undergoing lumbar decompression as the initial procedure were more likely to have a delayed diagnosis of TSS (8 versus 2 patients, P = .0200). The most common presentation of delayed TSS was pain and myelopathic symptoms that persisted after decompressive surgery.

Conclusion: TSS should remain within the differential diagnosis for patients at initial presentation of spinal stenosis. In addition, suspicion of TSS should be heightened if preoperative symptoms fail to expectedly improve following decompression even if overt myelopathic signs are not present.

Level of evidence: 4.

Keywords: cervical decompression; delayed diagnosis; lumbar decompression; myelopathy; spinal stenosis; spine surgery; tandem spinal stenosis.

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Figures

Figure 1
Figure 1
Order of decompression. Patients were substratified into order of decompression (eg, CL refers to patients who first underwent cervical decompression and later went on to receive lumbar decompression; 1 patient received a cervical decompression followed by simultaneous thoracic and lumbar decompression, denoted CITL).
Figure 2
Figure 2
Authors' recommended diagnostic algorithm.
See this image and copyright information in PMC

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