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


Clinicians must be aware of the potential for TSS when assessing a patient presenting with stenotic symptoms attributed to one region of the spine. Comprehensive clinical and radiographic assessment of patients is essential to tease out the sometimes challenging constellation of symptoms and signs. Owing to the potentially catastrophic consequences of missing a cord-level stenosis, treating clinicians must be aware of aspects of the history, examination, and imaging findings that are related to increased risk of stenosis at other levels. A low threshold is needed for obtaining additional advanced imaging.

In general, patients with TSS should undergo staged decompression. Preference should be given to address most proximal stenosis first, unless it is clear that the lumbar spine disease predominates and that the cord is not compromised—this reduces the risk of catastrophic complication and allows observation to determine whether symptoms from the distal stenosis improve as well.