Lumbar stenosis is a common clinical entity, i.e., being diagnosed with increasing frequency in our aging population in the United States. The process of spondylitic degeneration that causes lumbar stenosis may also give rise to concurrent cervical stenosis, resulting in so-called tandem stenosis. Symptomatic tandem spinal stenosis is characterized clinically by a combination of claudication and progressive gait disturbance with signs of mixed myelopathy and polyradiculopathy in both the upper and lower extremities.

A retrospective review of 361 patients, referred to our clinic for evaluation of lumbar stenosis over a period of 4 years, was conducted. Data collection consisted of detailed chart review and tabulation of the duration of symptoms, course of nonsurgical therapy, sensory and motor deficits, gait/balance disturbances, upper motor neuron signs, and diagnostic imaging studies. Patients with signs and symptoms suggestive of cervical spondylitic myelopathy underwent confirmatory diagnostic imaging studies.

Twenty-one of the 361 patients (5.8%) were found to have symptomatic tandem stenosis with clear clinical evidence of cervical myelopathy. Twelve of the 21 patients underwent cervical decompression; of these four underwent cervical decompression followed by lumbar decompression, and one patient underwent cervical decompression followed by thoracic decompression. Eight of the 21 patients underwent lumbar decompression only. One patient underwent lumbar decompression followed by cervical decompression.

The possibility of concurrent disease in both the cervical and lumbar spines reinforces the need for a thorough history and physical examination. Recognition and diagnosis of tandem stenosis is critical in determining the correct surgical sequencing and technique for treatment as spinal cord compression from cervical stenosis has significant associated morbidity and mortality. The 5.8% rate of tandem stenosis in this series places it in the lower end of the range from previous reports. Furthermore, only 3% of all patients referred for surgical evaluation of lumbar stenosis were ultimately found to have cervical stenosis requiring surgical decompression.

Balamurali G, Gala VC, Voyadzis J-M, Rosen D, Burks A, Rice L, Fessler RG. Presence of Undiagnosed Cervical Myelopathy in Patients referred for Surgical Evaluation of Lumbar Stenosis. J Spinal Surg 2016;3(2):29-33.

Clinical methods of palpations of iliac crests and spinous processes for spinal-level localization (SLL) were evaluated for accuracy in lumbar and lumbosacral (LS) spinal surgeries through the posterior approach.

Hundred and seven successive patients operated for lumbar and LS diseases operated through the posterior approach in the last 2 years were evaluated prospectively for the accuracy of clinical methods for SLL. There were 76 males and 31 females. Age ranged from 16 to 70 years (average 43.5 years). Clinical methods for SLL included palpation of iliac crests and spinal processes in correlation with midline sagittal MR images. Surgical incision and further surgery were undertaken after confirmation of spinal level by intraoperative lateral radiograph of LS spine. Accuracy of SLL by clinical methods and surgical findings at various spinal levels was observed.

Spinous processes for SLL were accurate in 94.39% (n = 101) cases. The level of iliac crests were seen at or just below L3 and L4 spinous processes in 89.71% (n = 96) and 10.29% (n = 11) cases respectively. Various anatomical features like posterior surfaces of laminae, thecal sac, and positions of roots in the spinal canal were helpful in differentiating L5 to S1 level than levels above. Six errors in SLL in the study included five females with L4 to L5 prolapsed inter-vertebral disk (PIVD) and one male with L5 to S1 PIVD.

Spinal-level localization by clinical methods in correlation with MR images is unreliable especially in women and L4 to 5 level. Intraoperative findings of L5 to S1 interspace and S1 lamina show features that may help in SLL during surgery.

Jha DK, Pandey P, Jain M, Arya A, Kushwaha S, Kumari R. Clinical Methods of Spinal-level Localization in Lumbar and Lumbosacral Spine Surgeries through Posterior Approach. J Spinal Surg 2016;3(2):34-39.

This is a report on the early clinical outcome of the BacJac interspinous distraction device in patients with lumbar spinal stenosis.

This is a prospective study on a group of patients who underwent surgery from February 2010 to December 2012. There were 21 consecutive patients who had insertion of a BacJac. Data prospectively recorded included Visual Analogue Scores for leg pain (VL), back pain (VB), the Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and walking distance (WD). Scores were recorded pre- and postoperatively and at final review. The follow-up period varied from 6 to 40 months.

We found all clinical outcome measures improved following surgery. Mean scores for VL improved from 76 to 27, for VB from 49 to 24, and for ODI from 42 to 26 at final follow-up. There were also improvements noted in ZCQ scores and patient-reported WD. We also noted a high rate of osteolysis (76%) around the implant at 1 year from insertion.

This small prospective study suggests that there is a role for the use of the BacJac interspinous distraction devices in selected patients. Osteolysis around the implant remains an issue although this did not appear to compromise the early outcome in this study.

Srinivasan SH, Newey M. A Report on the early Results of the BacJac Interspinous Distraction Device: A Prospective Study in Patients with Lumbar Spinal Stenosis. J Spinal Surg 2016;3(2):40-43.

Gopal VV, Balakrishnan PK. Conservative Management in Cervical Spinal Epidural Hematoma–A New Treatment Paradigm: Critical Review. J Spinal Surg 2016;3(2): 44-47.

Tripathi SK, Nanda SN, Reddy CR, Ranvir ST, Pawar SK, Kohli A, Vatchha S. Vacuum-assisted closure Dressing in Spine: An Emerging Trend. J Spinal Surg 2016;3(2):48-50.

Gopal VV. Atlantoaxial Fixation–Anterior or Posterior Approach: Critical Review. J Spinal Surg 2016;3(2):51-54.

Nomura H, Yanagisawa Y, Arima J. A Case of Recurrent Cervical Spondylolisthesis following Cervical Laminoplasty. J Spinal Surg 2016;3(2):55-58.

Jain N, Narayan S, Patil H, Songara A. Epidermoid Cyst of the Thoracic Spine: A Rare Case. J Spinal Surg 2016;3(2):59-62.

Selvan R, Ramkumar R, Subikshavarthni S. Unique Case of Glass Piece Injury to Cervical Spinal Cord: A Very Rare Presentation. J Spinal Surg 2016;3(2):63-65.

Mahalingam SS. Victor Horsley and Spinal Surgery. J Spinal Surg 2016;3(2):68-69.

Murugesan G. Dysphagia caused by Anterior Cervical Osteophytes at C2-C3: Unusual Location and Presentation. J Spinal Surg 2016;3(2):70-71.

Songara A, Patil H. Postoperative Meningocele Spurious. J Spinal Surg 2016;3(2):72-73.