TY - JOUR T1 - Delayed Diagnosis of Tandem Spinal Stenosis: A Retrospective Institutional Review JF - International Journal of Spine Surgery JO - Int J Spine Surg DO - 10.14444/6038 SP - 6038 AU - Amit Bhandutia AU - Luke Brown AU - Alysa Nash AU - Ian Bussey AU - Mark Shasti AU - Eugene Koh AU - Kelley Banagan AU - Steven Ludwig AU - Daniel Gelb Y1 - 2019/07/01 UR - http://ijssurgery.com//content/early/2019/07/09/6038.abstract N2 - Background Tandem spinal stenosis (TSS) is defined as simultaneous spinal stenosis in the cervical, thoracic, and/or lumbar regions and may present with both upper and lower motor neuron symptoms, neurogenic claudication, and gait disturbance. Current literature has focused mainly on the prevalence of TSS and treatment methods, while the incidence of delayed TSS diagnosis is not well defined. The purpose of this study was to determine the incidence of delayed TSS diagnosis at our institution and describe the clinical characteristics commonly observed in their particular presentation.Methods Following institutional review board approval, an institutional billing database review was performed for patients who underwent a spinal decompression procedure between 2006 and 2016. Thirty-three patients who underwent decompression on 2 separate spinal regions within 1 year were included for review. Patients with delayed diagnosis of TSS following the first surgery were differentiated from those with preoperative diagnosis of TSS.Results TSS requiring surgical decompression occurred in 33 patients, with the incidence being 2.06% in this cohort. Fifteen patients received a delayed diagnosis after the first surgical decompression (45%) and were found to have a longer interval between decompressions (7.6 ± 2.1 months versus 4.01 ± 3 months, P = .0004). Patients undergoing lumbar decompression as the initial procedure were more likely to have a delayed diagnosis of TSS (8 versus 2 patients, P = .0200). The most common presentation of delayed TSS was pain and myelopathic symptoms that persisted after decompressive surgery.Conclusion TSS should remain within the differential diagnosis for patients at initial presentation of spinal stenosis. In addition, suspicion of TSS should be heightened if preoperative symptoms fail to expectedly improve following decompression even if overt myelopathic signs are not present.Level of Evidence 4 ER -