Abstract Concurrent cervical and lumbar stenosis, also known as tandem spinal stenosis (TSS), is a rare degenerative disease that affects multiple spinal levels and is poorly described in the literature regarding its incidence, natural history, and operative management strategies. To study the frequency, natural history, and outcome of TSS in surgically treated patients and to design a surgical outcome clinical scoring tool to be used as an adjunct to clinical decision making in patients with TSS. The study was conducted in the Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi. A retrospective review of clinical and radiological hospital records was conducted for patients who underwent surgical treatment between January 2007 and December 2020. Functional outcomes were assessed using the Nurick, modified Japanese Orthopaedic Association (mJOA), and Oswestry Disability Index (ODI) scores. Cervical surgery included either anterior (discectomy or corpectomy and fixation) or posterior (laminoplasty or laminectomy and fixation), and discectomy ± laminectomy was done for lumbar afflictions. Machine learning using the GPT-4o language learning model was used to create a predictive model for determining surgical success using a combination of preoperative parameters based on the 12-year dataset. Out of 1,673 cases of cervical and/or lumbar degenerative disease surgically treated during this period, concurrent stenosis was identified in 122 cases (96 male, 26 female), out of which 3 cases were excluded due to mortality/loss to follow-up in the postoperative period (n = 119). The mean age was 59 ± 11.8 years (27–83 years) with a mean postoperative follow-up of 14.25 months (5–60 months). Only cervical decompression was done in 73 patients (61%), and only lumbar surgery was done in 23 patients (19%). Both surgeries were done in 23 patients (19%). Of the patients requiring surgery at both levels, single-stage cervical and lumbar surgery was done in 12 patients (10%), and staged surgery (cervical followed by lumbar) was done in the remaining cases. A total of 84 patients underwent cervical surgery (70.58%), out of which 11 patients needed lumbar surgery in follow-up. The mean interval between the staged procedures was 17 months. The difference in pre- and postoperative functional outcomes on ODI, Nurick, and mJOA scores independently in all groups of surgery was significant (p 0.05). The clinical scoring tool helps predict surgical benefit in patients with TSS, with a negative predictive value of 69.23%. It can be used as an adjunct for deciding the surgical strategy in TSS patients. Although the incidence of coexisting stenosis is low, it should not be overlooked. Deciding whether to operate on either cervical or lumbar or both levels is an essential dilemma in patients with TSS, and the TSS surgical outcome predictive tool can help in identifying patients who do not require two-level surgery and thus avoid the surgical morbidity associated with both-level surgery.
Mohapatra et al. (Fri,) studied this question.