title: Asymptomatic Stenosis in the Cervical and Thoracic Spines of Patients with Symptomatic Lumbar Stenosis.
abstract: Study Design Retrospective study. Objective Studies on age-related degenerative changes causing concurrent stenoses in the cervical, thoracic, and lumbar spines (triple stenosis) are rare in the literature. Our objectives were to determine: (1) the incidence of asymptomatic radiologic cervical and thoracic stenosis in elderly patients with symptomatic lumbar stenosis, (2) the incidence of concurrent radiologic spinal stenosis in the cervical and thoracic spines, and (3) the radiologic features of cervical stenosis that might predict concurrent thoracic stenosis. Methods Whole-spine T2 sagittal magnetic resonance images of patients older than 80 and diagnosed with lumbar spinal stenosis between January 2003 and January 2012 were evaluated retrospectively. We included patients with asymptomatic spondylotic cervical and thoracic stenosis. We measured the anteroposterior diameters of the vertebral body, bony spinal canal, and spinal cord, along with the Pavlov ratio and anterior or posterior epidural stenosis at the level of the disk for each cervical and thoracic level. We compared the radiologic parameters between the subgroups of cervical stenosis with and without thoracic stenosis. Results Among the 460 patients with lumbar stenosis, 110 (23.9%) had concurrent radiologic cervical stenosis and 112 (24.3%) had concurrent radiologic thoracic stenosis. Fifty-six patients (12.1%) had combined radiologic cervical and thoracic stenosis in addition to their symptomatic lumbar stenosis (triple stenosis). Anterior epidural stenosis at C7-T1 was associated with a high prevalence of thoracic stenosis. Conclusions It appears that asymptomatic radiologic cervical and thoracic stenosis is common in elderly patients with symptomatic lumbar stenosis.
authors.affiliation: Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University, Gyeonggi-do, Republic of Korea.
authors.forename: Moon Soo
authors.initials: MS
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Seong-Hwan
authors.initials: SH
authors.lastname: Moon
authors.affiliation: Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University, Gyeonggi-do, Republic of Korea.
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University, Gyeonggi-do, Republic of Korea.
authors.forename: Jae Keun
authors.initials: JK
authors.lastname: Oh
authors.affiliation: Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University, Gyeonggi-do, Republic of Korea.
authors.forename: Ho Dong
authors.initials: HD
authors.lastname: Lyu
authors.affiliation: Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University, Gyeonggi-do, Republic of Korea.
authors.forename: Jae-Hoo
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Washington University Orthopedics, BJC Institute of Health at Washington University School of Medicine, St. Louis, Missouri, United States.
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Riew
keywords: cervical spine; concurrent stenosis; lumbar spine; thoracic spine