title: Coexisting lumbar and cervical stenosis (tandem spinal stenosis): an infrequent presentation. Retrospective analysis of single-stage surgery (53 cases).
abstract: METHODS
  Retrospective analysis of 53 patients who underwent single stage simultaneous surgery for tandem spinal stenosis (TSS) at single centre.
  
  
  OBJECTIVE
  To discuss the presentation of combined cervical and lumbar (tandem) stenosis and to evaluate the safety and efficacy of single-stage simultaneous surgery. Combined stenosis is an infrequent presentation with mixed presentation of upper motor neuron and lower motor neuron signs. Scarce literature on its presentation and management is available. There is a controversy in the surgical strategy of these patients. Staged surgeries are frequently recommended and only few single-stage surgeries reported.
  
  
  METHODS
  All the patients were clinico-radiologically diagnosed TSS. Surgeries were performed in single stage by two teams. Results were evaluated with Nurick grade, modified Japanese Orthopedic Association score (mJOA), oswestry disability index (ODI), patient satisfaction index, mJOA recovery rate, blood loss and complication.
  
  
  RESULTS
  The mJOA cervical and ODI score improved from a mean 8.86 and 68.15 preoperatively to 13.00 and 30.11, respectively, at 12 months and to 14.52 and 24.03 at final follow-up. The average mJOA recovery rate was 48.23 ± 26.90 %. Patient satisfaction index was 2.13 ± 0.91 at final follow-up. Estimated blood loss of ≤400 ml and operating room time of <150 min showed improvement of scores and lessened the complications. In the age group below 60 years, the improvement was statistically significant in ODI (p = 0.02) and Nurick's grade (p = 0.03) with average improvement in mJOA score.
  
  
  CONCLUSIONS
  Short-lasting surgery, single anaesthesia, reduced morbidity and hospital stay as well as costs, an early return to function, high patient satisfaction rate with encouraging results justify single-stage surgery in TSS. Age, blood loss and duration of surgery decide the complication rate and outcome of surgery. Staged surgery is recommended in patients above the age of 60 years.
authors.affiliation: "STAVYA" Spine Hospital and Research Institute, Nr. Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, 380006, Gujarat, India, drajaykrishnan@yahoo.co.in.
authors.forename: Ajay
authors.initials: A
authors.lastname: Krishnan
authors.forename: Bharat R
authors.initials: BR
authors.lastname: Dave
authors.forename: Arun Kumar
authors.initials: AK
authors.lastname: Kambar
authors.forename: Himanshu
authors.initials: H
authors.lastname: Ram
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013130:Spinal Stenosis / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome