Evaluation and Treatment of Tandem Spinal Stenosis

Joseph F. Baker, MCh, FRCSI


J Am Acad Orthop Surg. 2020;28(6):229-239. 

In This Article

Abstract and Introduction


Tandem spinal stenosis (TSS) refers to simultaneous narrowing of noncontiguous regions of the spinal canal, typically the cervical and lumbar region. Symptomatic TSS may be present in more than 10% of patients presenting with spinal symptoms secondary to stenosis in any one region. Clinical presentation may present challenges because of a mixture of upper and lower motor neuron lesions that can confuse and mislead the clinician. Stenosis at another level may only be detected late, when there is failure to improve after treatment, and, if not detected, can result in either poor treatment outcomes or catastrophic complications. There is no uniform agreement in the management of TSS, and the reported surgical strategies include both simultaneous and staged approaches with each having positive and negative features. This article aims to provide the reader with details on the prevalence, evaluation, and guidance in treatment strategy for TSS.


Spinal stenosis can be simply defined as a reduction in cross-sectional area of the spinal canal. Stenosis is most often "acquired" as a result of degenerative disease of the disk, facet joints, and ligamentum flavum, leading to a reduction in spinal canal dimension, or may be "congenital" with the loss in canal dimensions present at the level of the pedicle—both can be associated with compromise of the neural elements. Although stenosis may be asymptomatic, it is most frequently encountered in the lumbar spine, classically presenting with spinal claudication and/or features of lumbar radiculopathy.

However, stenosis may also occur at any level throughout the spinal column including cervical and, less commonly, thoracic—tandem spinal stenosis (TSS) is defined as stenosis affecting two or more noncontiguous anatomic regions of the spine. Classically, TSS is considered as the one which simultaneously affects the cervical and lumbar region, but the thoracic spine can also be involved, and in rare instances, all three regions of the spine may be affected simultaneously.[1–3]

TSS may present with a constellation of symptoms and signs that can confuse and mislead the clinician. It may be difficult to persuade a patient presenting with lumbar spine–dominant symptoms that a previously undetected cervical spinal stenosis (CSS) is a greater priority for intervention and vice versa. The aim of this review is to provide guidance for the clinician in the diagnosis and treatment of patients with TSS.