Patients with Tandem Spinal Stenosis Changbo Lu, Haiyang Qiu, Xinyi Huang, Xiaojiang Yang, Daming Liu, Saili Zhang, Yang Zhang

BACKGROUND: Tandem spinal stenosis (TSS) refers to simultaneous spinal canal stenosis of noncontiguous re- gions. There is no consensus in the surgical strategies for patients with symptomatic TSS because of the confusing clinica! manifestations. This meta-analysis aimed to compare the outcomes of 1-stage and 2-stage decompres sion of all stenotic regions (cervical and lumbar/thoracic segments) in patients with TSS.
METHODS: A systematic review was conducted, and a comprehensive literature search with the Japanese Or thopedic Association score, was carried out using MED- LINE. Web of Science, and PubMed databases from inception to September 13, 2022. Observational studies reporting the outcomes after 1-stage or 2-stage decom- pression of all symptomatic regions were included. Possible heterogeneity among studies was assessed by the Higgins test, and heterogeneity was statistically inves tigated using the a statistic.
RESULTS: Thirteen retrospective observational studies were included in this meta-analysis. Meta-analysis showed that there was no significant difference in the Japanese Orthopedic Association score improvement in patients with TSS involving either the cervical-thoracic on cervical-lumbar segments. Regarding the surgical param- eters and complications, 1-stage decompression showed comparable operation time, blood loss, and major compli- cations to 2-stage decompression in patients with cervical and lumbar TSS. In patients with cervical and thoracic TSS, 1-stage decompression had significant advantages compared with 2-stage decompression in operation time, blood loss, and major complications.
CONCLUSIONS: For patients with cervical and lumbar TSS, 24tage decompression showed slight advantages in clinical outcome without exposing patients to unnecessary surgical risks. For patients with cervical and thoracic TSS, 1-stage decompression showed comparable clinical outcome, although with better operative parameters and lower complication rate than in simultaneous decompression.