Patients with "Lumbar Stenosis" and Unrecognized Distal Thoracic Cord Compression

Abstract

Study Design: This is a retrospective analysis of 3 patients with MR-documented lumbar spinal stenosis found to have myelopathy and distal thoracic cord compression. Objectives: To emphasize that some patients lumbar stenosis/radiculopathy may also be myelopathic, and should undergo MR evaluations of the cervical/ thoracic spine. Summary of Background Data: Patients presenting with the diagnosis of lumbar spinal stenosis supported by MR studies should be fully examined to determine whether thoracic myelopathy is superimposed on lumbar radiculopathy. Methods: Three patients presented with MR-documented lumbar spinal stenosis/spondyloarthrosis, and ossification of the yellow ligament [OYL]. However, when all 3 also exhibited severe thoracic myelopathy/parapareses, they underwent thoracic MR/CT studies which documented; [1] TI0/11 right-sided disc, and severe stenosisIOYL T9-T12 OYL [mild/moderate L3-SI OYL was not operated upon-1 patient], [2] T9/10 and TI0/1 1 synovial cysts, and severe stenosis T8-SI OYL [1 patient], and [3] TI0/1 1 synovial cyst and severe stenosisIOYL TIO-S I [1 patient]. Results: The first patient underwent a TI0/1 1 right-sided diskectomy, and T9-T12 Iaminectomy alone. Two patients had thoracic laminectomies for synovial cysts/OYL, and lumbar laminectomies for severe stenosis/OYL; T8-SI and T9-Sl. Utilizing Odom's criteria, 2 patients exhibited excellent outcomes 6 and 9 months, while I demonstrated a fair/good recovery [T8-S I Iaminectomy] 3 months postoperatively. Conclusions: A subset of patients with MR-documented lumbar spinal stenosis/radiculopathy may exhibit simultaneous thoracic myelopathy. Where thoracic cord compression is documented, thoracic/thoracolumbar laminectomies may become warranted.