title: A rare case of multiregional spinal stenosis: clinical description, surgical complication, and management concept review.
abstract: Study Design Case report and literature review. Objective Multiregional spinal stenosis (MRSS) has not been described in the English literature, although a few studies report the concept of tandem spinal stenosis. Due to the concurrent spinal stenosis occurring in three separate regions of the spine, clinical presentation of MRSS may be less distinct, and its surgical treatment priorities and challenges differ from single-region spinal stenosis. The purpose of this article is to describe a new concept and a rare case of MRSS as separated segments of spinal stenosis in the cervical, thoracic, and lumbar spine. Methods A retrospective case description of MRSS and surgical strategies used in managing such extensive multiregional stenosis and its potential complications. Results  A novel surgical strategy using a combination of laminectomies with fusion and laminoplasty without fusion to treat this patient with such extensive cervical to thoracic myelopathic cord compression is described. Initial good recovery after cervical cord decompression was followed by a delayed recurrence of symptoms from thoracic cord compression. The subsequent thoracic surgical decompression, its complications and management, and patient recovery are discussed with a literature review highlighting the possible mechanisms for postoperative loss of neurologic function after thoracic decompression. Conclusion MRSS is a rare cause of extensive compression of multiple regions of the spinal cord. To the best of the authors' knowledge, this report is the first to use the term multiregional spinal stenosis to describe this new emergent clinical entity, surgical management strategies, and potential complications.
authors: University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore.
authors: Choon Chiet
authors: CC
authors: Hong
authors: University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore.
authors: Ka Po Gabriel
authors: KP
authors: Liu
keywords: multiregional spinal stenosis; ossified posterior longitudinal ligament; ossified yellow ligament; tandem stenosis
references: J Neurosurg. 1987 Jun;66(6):842-9
references: 3572515
references: J Bone Joint Surg Br. 1974 May;56(2):225-35
references: 4854669
references: Spine J. 2003 Mar-Apr;3(2):125-9
references: 14589226
references: J Bone Joint Surg Br. 2005 Sep;87(9):1248-52
references: 16129751
references: J Spinal Disord Tech. 2006 Dec;19(8):603-6
references: 17146305
references: Eur Spine J. 2009 Jul;18(7):943-8
references: 19347374
references: Chang Gung Med J. 2005 Apr;28(4):254-7
references: 16013345
references: Neurosurgery. 1996 Sep;39(3):494-508; discussion 508-9
references: 8875479
references: Arch Neurol. 1964 Mar;10:298-307
references: 14106986
references: J Neurosurg Spine. 2010 Jul;13(1):116-22
references: 20594026
references: Circ Res. 1977 Jul;41(1):128-34
references: 862136
references: Spine (Phila Pa 1976). 2002 Aug 1;27(15):1670-3
references: 12163731