Risk factors and outcomes in thoracic stenosis with myelopathy: A single center experience.
OBJECTIVE
Identify risk factors predisposing to thoracic spinal stenosis and myelopathy (TS) and address treatment options and outcomes.


METHODS
A retrospective review of our center's experience with TS over 10 years. Clinical and magnetic resonance imaging (MRI) data, surgical intervention and outcomes using Frankel and Japanese Orthopedic Association (JOA) scales were collected.


RESULTS
A total of 44 patients with TS were identified. There were 30 men and 14 women with a mean age±SD of 66±15years. Neurological performance was evaluated using the Frankel scale (A-E or 1-5), and JOA scale for myelopathy (0-11). Frankel scores (1-5) and JOA scores (0-11) on admission were 3.5±0.9 and 6.8±2.6 respectively. At follow-up, Frankel scores had improved to 4.1±0.8 (p=0.041) and JOA scores had improved to 8.3±2.4 (p=0.021). The presence on admission of increased signal from the cord on T2-weighted MRI was associated with lower Frankel and JOA scores (3.3±0.9, and 6.2±2.5 respectively) than in those with absent increased signal (4.0±0.4 and 8.6±2.1, p=0.02 and p=0.008 respectively). There were 4 complications, requiring exploration and debridement for dehiscence in 3 and an epidural hematoma in the fourth that necessitated evacuation, with a good outcome. A fifth patient underwent reoperation at the same level 18 months later for persistent stenosis.


CONCLUSIONS
Thoracic stenosis with myelopathy should be entertained in patients with myelopathy. Over half of our patients with TS were over the age of 70, and men outnumbered women by a ratio of 2:1. Nearly half the patients with TS had concomitant cervical and/or lumbar degenerative disease warranting surgery also. Increased signal intensity on T2-weighted MRI images correlated with lower Frankel and JOA scores compared to those without. Decompression for thoracic stenosis is associated with neurological improvement.
Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA. Electronic address: patrick-hitchon@uiowa.edu.
Patrick W
PW
Hitchon
Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Kingsley
K
Abode-Iyamah
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Nader S
NS
Dahdaleh
Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Andrew J
AJ
Grossbach
Department of Neurological Surgery, St. Louis University School of Medicine, St Louis, MO, USA.
Najib E
NE
El Tecle
Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Jennifer
J
Noeller
Department of Neurology & Neurosciences, Rutgers-New Jersey Medical School, Newark, NJ, USA.
Wenzhuan
W
He
D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery
MRI signal change; Thoracic laminectomy; Thoracic myelopathy; Thoracic stenosis