Should asymptomatic cervical stenosis be treated in the setting of progressive thoracic myelopathy? A systematic review of the literature.

PURPOSE: Unlike tandem stenosis of the cervical and lumbar spine, tandem cervical and thoracic stenosis (TCTS) of the spine is less common, and the approach and order of intervention are controversial. We aim to review the literature to evaluate the incidence and interventions for patients with cervical and thoracic stenosis. We provide illustrative cases to demonstrate that thoracic myelopathy in the setting of asymptomatic cervical stenosis can be treated safely.

METHODS

A systematic review of the literature through electronic databases of PubMed, EMBASE, Web of Science, and Cochrane Library was performed to present the current literature that evaluates TCTS as it relates to incidence and surgical interventions. We also present two cases of patients undergoing operative intervention for thoracic myelopathy in the setting of concurrent cervical stenosis.

RESULTS

A total of 26 English original studies and case reports were identified. Nine studies evaluated the incidence of TCTS. 20 studies with a total of 168 patients with TCTS presented information on surgical intervention options. There is an overall aggregate incidence of 11.6% (530/4751) based on incidence studies. 165 patients underwent thoracic intervention. Of these patients, 63 patients underwent cervical intervention first, 29 underwent thoracic intervention first, and 73 underwent simultaneous, single-stage intervention.

CONCLUSIONS

In patients presenting with myelopathy, both cervical and thoracic spine should be evaluated for TCTS. Order of operative intervention is tailored to clinical and radiographic information. In cases of thoracic myelopathy with asymptomatic cervical stenosis, thoracic intervention can be pursued with precautions to prevent further cervical cord injury.