Neurological deterioration due to missed thoracic spinal stenosis after decompressive lumbar surgery: A report of six cases of tandem thoracic and lumbar spinal stenosis.
There have been a few reports of patients with a combination of lumbar and thoracic spinal stenosis. We describe six patients who suffered unexpected acute neurological deterioration at a mean of 7.8 days (6 to 10) after lumbar decompressive surgery. Five had progressive weakness and one had recurrent pain in the lower limbs. There was incomplete recovery following subsequent thoracic decompressive surgery. The neurological presentation can be confusing. Patients with compressive myelopathy due to lower thoracic lesions, especially epiconus lesions (T10 to T12/L1 disc level), present with similar symptoms to those with lumbar radiculopathy or cauda equina lesions. Despite the rarity of this condition we advise that patients who undergo lumbar decompressive surgery for stenosis should have sagittal whole spine MRI studies pre-operatively to exclude proximal neurological compression.
Kizawa Memorial Hospital, Department of Orthopaedic Surgery, 590 Shimokobi, Kobichou, Minokamo City, Gifu 505-8503, Japan.
K
K
Fushimi
K
K
Miyamoto
A
A
Hioki
H
H
Hosoe
A
A
Takeuchi
K
K
Shimizu
D000208:Acute Disease; D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D003951:Diagnostic Errors; D018450:Disease Progression; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016879:Salvage Therapy / Q000379:methods; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology*; D013130:Spinal Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed
Lumbar spinal stenosis (LSS); Tandem spinal stenosis (TSS); Thoracic myelopathy