title: One-staged combined decompression for the patients with cervico-thoracic tandem spinal stenosis.
abstract: To report the techniques and safety of one-staged combined decompression for the patients with tandem spinal stenosis (TSS) at cervical and thoracic spine.
  
  
  
  Sixteen TSS subjects, who received combined decompression from Aug 2005 to Feb 2012, were reviewed. The essentials of our surgical strategy included: choosing patients with TSS from cervical to upper or middle thoracic spine, using one single posterior incision, simplifying surgical maneuvers and performing circumferential decompression for thoracic compression if it was indicated. The Japanese Orthopedic Association (JOA) scale for cervical myelopathy was employed to evaluate the neurological status, and Hirabayashi's system to assess neurological recovery rate.
  
  
  
  The average operation duration, blood loss and postoperative hospitalization were 242.8 ± 89.9 min, 1581.3 ± 1237.2 ml and 11.9 ± 7.5 days, respectively. Six subjects (37.5 %) suffered instant neurological deterioration. Other complications included cerebrospinal fluid leakage (10 subjects, 62.5 %), new radiculopathy (two subjects), urinary infection, lung infection and pulmonary thromboembolism. Four subjects received extra-thoracic decompression due to the remaining anterior compression in one subject and new emerging compression in other three subjects. Eventually, mean JOA score was elevated from 9.8 ± 2.1 to 13.7 ± 2.7 after this procedure, and the neurological recovery of seven subjects was rated as excellent, four as good, two as fair, three as unchanged or deteriorated. The overall recovery rate was 53.7 %.
  
  
  
  Combined cervico-thoracic decompression could provide fair neurological outcomes for patients with cervico-thoracic TSS, but it was complicated with high rate of undesirable postoperative events. So, more efforts should be done against its eventful postoperative course before its wide application.
authors.affiliation: Department of Orthopedics, Peking University Third Hospital, No. 49 Huayuanbei Rd, Haidian District, Beijing, 100191, China.
authors.forename: Panpan
authors.initials: P
authors.lastname: Hu
authors.affiliation: Department of Orthopedics, Peking University Third Hospital, No. 49 Huayuanbei Rd, Haidian District, Beijing, 100191, China.
authors.forename: Miao
authors.initials: M
authors.lastname: Yu
authors.affiliation: Department of Orthopedics, Peking University Third Hospital, No. 49 Huayuanbei Rd, Haidian District, Beijing, 100191, China. puth_lxg@163.com.
authors.forename: Xiaoguang
authors.identifier: 0000-0002-5284-6097
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Peking University Third Hospital, No. 49 Huayuanbei Rd, Haidian District, Beijing, 100191, China.
authors.forename: Zhongjun
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Peking University Third Hospital, No. 49 Huayuanbei Rd, Haidian District, Beijing, 100191, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Department of Orthopedics, Peking University Third Hospital, No. 49 Huayuanbei Rd, Haidian District, Beijing, 100191, China.
authors.forename: Zhongqiang
authors.initials: Z
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D012189:Retrospective Studies; D013130:Spinal Stenosis / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery*
keywords: Cervical spine; One-staged decompression; Surgical outcomes; Tandem spinal stenosis; Thoracic spine