• Andrew A Ronald, Mayank Kaushal, Raleigh Ems, Collin Labak, James Wright, Christina Huang Wright, Martha Sajatovic, and Manish K Kasliwal.
• Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
• World Neurosurg. 2020 Nov 1; 143: 546-552.e1.

BackgroundA scarcity of data has been reported on tandem thoracic lumbar stenosis, which might be related to either the rarity or underdiagnosis of the condition. We have presented a systematic review of the clinical presentation, diagnosis, and treatment patterns for patients with symptomatic tandem thoracic and lumbar stenosis.MethodsA PubMed/MEDLINE search was performed to find reports of patients with symptomatic tandem thoracic and lumbar stenosis.ResultsThe review identified 10 studies with a total of 48 patients with tandem thoracic and lumbar stenosis. Most patients (n = 41; 85%) had had tandem stenosis diagnosed at the initial investigation, with 71% of the reports citing ossification of the ligamentum flavum as a contributing etiology. A few patients (n = 7; 15%) had had thoracic lesions diagnosed after neurologic deterioration that had occurred after lumbar surgery for previously suspected isolated lumbar stenosis. Surgical management varied from isolated thoracic decompression, staged decompression, and simultaneous decompression. Most patients (n = 41; 87%) showed improved neurologic status after surgery.ConclusionOssification of the ligamentum flavum might play a key role in the pathogenesis of the condition. Most patients with tandem thoracic and lumbar stenosis will show improvement after surgical decompression. Although the limited evidence available has raised concerns regarding neurologic deterioration after initial lumbar decompression in patients with coexisting thoracic stenosis, the data are insufficient to definitively determine an optimal surgical strategy. Further research is needed to identify the optimal diagnostic and management criteria for patients with symptomatic tandem thoracic and lumbar stenosis.Copyright © 2020 Elsevier Inc. All rights reserved.

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