Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparison of 1-Stage versus 2-Stage Decompression, Fusion and Instrumentation Surgery in Patients with Coexisting Cervical and Lumbar Degenerative Spondylotic Disorders; A Prospective, Randomized, Controlled Clinical Trial Study

Document Type : Original Article (s)

Authors
Majid Rezvani 1
Alireza Ghaed-Amini 2
Homayoon Tabesh 1
1 Assistant Professor, Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Coexistent involvement of cervical and lumbar spine with destructive spondylotic degenerative processes such as tandem spinal stenosis (TSS) can be managed with simultaneous or staged decompressions; though, a controversy exists regarding the surgical staging strategy and limited research is available on its operative management which are mostly retrospective. This randomized clinical trial was conducted to compare outcomes of simultaneous decompression, fusion and instrumentation of cervical and lumbar spine versus 2-stage operations.Methods: Twenty patients with TSS were randomly assigned to either of two groups; in the 1-stage group, simultaneous decompression, fusion and instrumentation of both cervical and lumbar spine were performed by two teams in a single operation. The 2- stage group underwent staged cervical and lumbar surgeries in 2 separate operations. Combined blood loss, transfused packed cells, operation time, recovery time, days of hospitalization, overall expenses, Oswestry Disability Index (ODI) and complications were compared between the two groups. Student T-test, Chi-square test and Pearson correlation were used for analyzing the data.Findings: Operation time, recovery time, days of hospitalization and overall expenses were significantly reduced in 1-stage surgery group. There were no significant differences between the two groups in terms of combined blood loss, transfused packed cells or postoperative complications. Early cervical and lumbar clinical outcomes which were evaluated by Oswestry neck and back disability index, respectively, were similar in two groups (P > 0.05).Conclusion: Single-stage surgery had comparable clinical outcomes compared to 2-stage operations without exposing the patients to unnecessary risks.
Keywords
Tandem spinal stenosis
1-stage
2-stage
Decompression
Fusion and instrumentation surgery
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Journal of Isfahan Medical School
Volume 34, Issue 371 - Serial Number 371
January and February 2016
Pages 80-89

  • Receive Date 05 March 2015
  • Accept Date 06 April 2022