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A rare case of multiregional spinal stenosis: clinical description, surgical complication, and management concept review.

ABSTRACT: Study Design Case report and literature review. Objective Multiregional spinal stenosis (MRSS) has not been described in the English literature, although a few studies report the concept of tandem spinal stenosis. Due to the concurrent spinal stenosis occurring in three separate regions of the spine, clinical presentation of MRSS may be less distinct, and its surgical treatment priorities and challenges differ from single-region spinal stenosis. The purpose of this article is to describe a new concept and a rare case of MRSS as separated segments of spinal stenosis in the cervical, thoracic, and lumbar spine. Methods A retrospective case description of MRSS and surgical strategies used in managing such extensive multiregional stenosis and its potential complications. Results A novel surgical strategy using a combination of laminectomies with fusion and laminoplasty without fusion to treat this patient with such extensive cervical to thoracic myelopathic cord compression is described. Initial good recovery after cervical cord decompression was followed by a delayed recurrence of symptoms from thoracic cord compression. The subsequent thoracic surgical decompression, its complications and management, and patient recovery are discussed with a literature review highlighting the possible mechanisms for postoperative loss of neurologic function after thoracic decompression. Conclusion MRSS is a rare cause of extensive compression of multiple regions of the spinal cord. To the best of the authors' knowledge, this report is the first to use the term multiregional spinal stenosis to describe this new emergent clinical entity, surgical management strategies, and potential complications.

SUBMITTER: Hong CC

PROVIDER: S-EPMC4303485 | biostudies-other | 2015 Feb

REPOSITORIES: biostudies-other

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Project description:IntroductionSymptomatic lumbar spinal stenosis is the most common indication for spinal surgery. However, more than one-third of the patients undergoing surgery for lumbar stenosis report dissatisfaction with the results. On the other hand, conservative treatment has shown positive results in some cases. This trial will compare the outcomes of surgical versus non-surgical treatment for lumbar stenosis. The study includes a multidimensional follow-up, aiming to study the association between outcome and other studied parameters, mainly electromyography and nerve conduction. Moreover, it may contribute to a better understanding of the pathophysiology of lumbar stenosis and to the development of future pharmacological treatments.Methods and analysisUppSten is a single-centre randomised controlled trial in which 150 patients with symptomatic lumbar spinal stenosis will be randomised into one of two treatment arms. The patients in the surgical arm will undergo laminectomy; the patients in the non-surgical arm will be given a structured physical training programme. The primary outcome of the study will be the Oswestry Disability Index. Secondary outcomes will include motor amplitude and degree of denervation activity obtained by means of nerve conduction studies and electromyography. Patient-reported outcome measures will be also used as secondary outcomes. Blood sample analysis and the investigation of potential inflammation markers are the additional secondary outcome parameters. Laboratory evaluation will include blood sample collection before the treatment initiation and after 6 months. Flavum ligament biopsies will be performed in the surgical group. Finally, tertiary outcomes will include neurophysiological measures, the objective walking ability and radiological evaluation.Ethics and disseminationThe study is approved by the Local Ethics Committee (Dnr 2017-506), the Hospital's Clinical Trials Committee (2018-0001) and the National Biobank Council and Uppsala Biobank (BbA-827-2018-025). The results will be presented in peer-reviewed journals and at international conferences.Trial registration numberNCT03495661.

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A rare case of multiregional spinal stenosis: clinical description, surgical complication, and management concept review.

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