title: Is there a difference between simultaneous or staged decompressions for combined cervical and lumbar stenosis?
abstract: METHODS
  We evaluated 43 patients diagnosed with tandem spinal stenosis (TSS) from 1999 to 2005 in an academic hospital.
  
  
  OBJECTIVE
  The purpose of this study is to compare outcomes after simultaneous decompression of the cervical and lumbar spine versus staged operations.
  
  
  BACKGROUND
  TSS is a rare degenerative disease affecting multiple spinal levels with limited research describing operative management.
  
  
  METHODS
  Of our patients, 21 underwent simultaneous decompression of both the cervical and lumbar spine and 22 underwent staged decompression of the cervical spine followed by the lumbar spine at a later date. Medical records were reviewed for patient demographics, type and duration of symptoms, operative time, combined blood loss, cervical myelopathy modified Japan Orthopaedic Association Score, Oswestry Disability Index (ODI), major and minor complications, and average length of follow up. Each category was evaluated by Pearson correlations and unpaired Student t tests.
  
  
  RESULTS
  With a mean follow-up of 7 years, both groups improved in JOA and ODI without a significant difference between the 2 operative groups in terms of major or minor complications, JOA, or ODI. Independent of the surgical algorithm, age above 68 years, estimated blood loss ≥400 mL, and operative time ≥150 minutes significantly increased the number of complications.
  
  
  CONCLUSIONS
  These results indicate that TSS can be effectively managed by either surgical intervention, simultaneous, or staged decompressions. However, patient age, blood loss, and operative time do significantly impact outcomes. Therefore, operative management should be tailored to the patient's age and the option which will limit blood loss and operative time, whether that is by simultaneous or staged procedures.
authors.affiliation: Department of Orthopaedic Surgery, University of Massachusetts School of Medicine, 119 Belmont Street, Worcester, MA 01605, USA. jonathaneskander@gmail.com
authors.forename: Mark S
authors.initials: MS
authors.lastname: Eskander
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Aubin
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Drew
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Eskander
authors.forename: Steve M
authors.initials: SM
authors.lastname: Balsis
authors.forename: Jason
authors.initials: J
authors.lastname: Eck
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Lapinsky
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Connolly
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013130:Spinal Stenosis / Q000601:surgery*; D016896:Treatment Outcome