Staged surgery for tandem cervical and lumbar spinal stenosis: Which should be treated first?

Chi An Luo, Arun Kumar Kaliya-Perumal, Meng Ling Lu, Lih Huei Chen, Wen Jer Chen, Chi Chien Niu*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

30 Scopus citations


Purpose: Tandem spinal stenosis (TSS) refers to lumbar and cervical spinal canal stenosis. Staged surgery is often chosen, but sometimes, mere decompression of one stenosis is adequate to relieve symptoms. Therefore, we intend to analyze whether starting with the cervical or the lumbar region is the most logical option. Methods: We retrospectively reviewed the data of 47 patients with TSS, having first-stage decompression for the most symptomatic stenosis, and classified into two groups (Group A: lumbar decompression first, Group B: cervical decompression first). Postoperative outcomes were analyzed for at least 2 years, and they were cautiously watched for symptoms of the non-operated stenosis; if such symptoms were debilitating, second-stage surgery for the non-operated stenosis was done. Results: The demographic characteristics of Group A (n = 11) and Group B (n = 36) were comparable. One patient (9%) in Group A and 25 patients (67%) in Group B had resolution of symptoms and good functional recovery. The need for a second-stage surgery for the non-operated stenosis was significantly high (p = 0.001) among patients in Group A. They suffered a significant worsening of both the mJOA score and the Nurick’s grade; whereas, patients in Group B experienced staged improvement of both scales. Conclusion: First-stage surgery for the cervical stenosis significantly lowers the need of the second-stage surgery. In contrast, if lumbar stenosis was treated first, a dramatic exacerbation of the symptoms related to the cervical stenosis can occur soon. Therefore, treatment of cervical stenosis first seems to be more appropriate. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].

Original languageEnglish
Pages (from-to)61-68
Number of pages8
JournalEuropean Spine Journal
Issue number1
StatePublished - 25 01 2019

Bibliographical note

Publisher Copyright:
© 2018, The Author(s).


  • Spondylosis
  • Staged operation
  • Surgical sequence
  • Tandem spinal stenosis


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