Single-stage surgery for compressive thoracic myelopathy associated with compressive cervical myelopathy and/or lumbar spinal canal stenosis.

PURPOSE: The clinical impact of the coexistence of compressive cervical myelopathy (CM) and/or lumbar spinal canal stenosis (LCS) with compressive thoracic myelopathy (TM) remains unknown. The purpose of this study was to examine the incidence, clinical pictures, and surgical outcomes of patients with compressive TM and the coexistence of compressive CM and/or LCS.

METHODS

We retrospectively reviewed 50 patients (18 women and 32 men; mean age 68.4 years) who underwent decompression surgery for TM. Mean follow-up period was 44 months. The incidence and clinical features of the coexistence of CM and/or LCS were investigated. The surgical outcomes after single-stage multilevel decompression surgery were also examined using the Japanese Orthopedic Association (JOA) scores.

RESULTS

Of 50 patients, 35 had concurrent CM and/or LCS (combined group), and the remaining 15 only had TM (T group). No significant differences were found with regard to sex, the etiology of TM, or the level of thoracic stenosis between the groups; however, the patients' age and preoperative JOA scores in the combined group were significantly higher than those in the T group. In both groups, the JOA score at the final follow-up significantly improved compared to the preoperative JOA score.

CONCLUSIONS

About 70 % of patients who underwent surgery for TM had concurrent CM and/or LCS, and they were initially diagnosed with CM or LCS. Single-stage multilevel decompression surgery for TM with concurrent CM and/or LCS is comparable to thoracic only surgery with regard to complications and surgical results, and it is well tolerated in elderly patients.