Surgical treatment of thoracic spinal stenosis - A 2-to 9-year follow-up

Study Design. A retrospective investigation of the results of operative tre atment of patients with symptomatic thoracic spinal stenosis. Objectives. To establish the effectiveness and define the limitations of su rgical treatment for stenosis of the thoracic spinal canal. Summary of Background Data. In contrast to cervical and lumbar stenosis, sy mptomatic narrowing of the thoracic spinal canal is rarely encountered. Alt hough the treatment of thoracic stenosis has been described in multiple cas e reports and in several small series with minimal follow-up evaluation, th ere are few studies of patients treated surgically for this condition with follow-up evaluation beyond 2 years. Methods. Twelve patients who underwent operative decompression for symptoma tic stenosis of the lower thoracic spine were followed up for an average pe riod of 62.4 months. Surgery was performed on the thoracic spine alone in f our cases and on the combined thoracolumbar spine in eight. Factors that we re investigated included pain severity, lower extremity motor function, amb ulatory status, and postoperative complications. Results. The level of pain after surgery was decreased in eight patients an d unchanged in four patients. Of the 10 patients with a motor deficit befor e surgery, eight had improvement of muscle function. Of the 11 patients wit h a gait disturbance before surgery, ambulatory status was improved in seve n, unchanged in two, and worse in two. One patient lost neural function sec ondary to surgical intervention. There were five cases in which the early r esult subsequently deteriorated because of recurrent stenosis, spinal defor mity/instability, or both. Conclusions. Thoracic stenosis can occur in isolation or, more commonly, in association with lumbar stenosis. Ideally, operative treatment should addr ess all stenotic segments and directly decompress the primary anatomic abno rmalities causing neural element compression. Although satisfactory short-t erm results can be expected, deterioration of the early outcome because of the potential for recurrent stenosis and deformity/instability at the thora columbar junction can sometimes be seen with longer follow-up evaluation pe riods.