Moderators: Evan K. Johnson, PT, DPT, OCS; Rick Placide, MD, PT
Data from current research indicates that stenosis in one part of the spine positively predicts for stenosis in another region of the spine. Tandem stenosis is an identifiable syndrome that results from canal narrowing of multiple areas of the spine that result in significant neurologic compression. Patients with symptomatic tandem stenosis may present with signs of neurogenic claudication, progressive gait disturbance, and findings of mixed myelopathy and radiculopathy. Patients who present with two sites of compressive stenosis may be misdiagnosed in clinical practice, as the patient exhibits an array of symptoms that could be caused by a variety of conditions including motor-neuron diseases.
This symposium will review the etiology, clinical presentation and management of patients with multiple sites of spinal stenosis. A multidisciplinary faculty will present the current literature on the relationship between cervical and lumbar spinal stenosis highlighting special considerations, examination techniques and treatment modalities in common conditions arising from concurrent cervical and lumbar spine stenosis. Indications for clinical examination techniques and treatment modalities in patients who present with tandem spinal stenosis will be presented with an emphasis on the clinical reasoning behind the sequence of management of tandem spinal stenosis and the identification of other disorders that can mimic this condition.
Upon completion of this session, participants should gain strategies to:
- Recognize distinctive characteristics of the history and physical examination of individuals who present with pain and disability arising from concurrent cervical and lumbar spine stenosis;
- Identify the advantages and disadvantages of specific imaging and ancillary testing for individuals who present tandem spinal stenosis;
- Integrate knowledge of spinal biomechanics with clinical findings to facilitate optimal triage of patients with pain and disability arising from tandem spinal stenosis in a manner consistent with best practice;
- Enhance the use of best practice examination and treatment techniques of individuals with tandem spinal stenosis, based on the most current evidence.
Agenda
Introduction/Welcome
Evan K. Johnson, PT, DPT, OCS and Rick Placide, MD, PT
Tandem Spinal Stenosis: What Does the Literature Tell Us about the Co-Occurrence of Cervical and Lumbar Spondylosis with Symptomatic Stenosis?
Evan K. Johnson, DPT, OCS
The Natural History and Mechanical Properties of Spinal Degeneration and Stenosis
Ron Alkalay, PhD
Alignment and Regional Interdependence of the Cervical and Lumbar Spine Regions
Virginie Lafage, PhD
Cervical and Lumbar Spine Degeneration: Physical Examination of the Patient with Tandem Spinal Stenosis
Rick Placide, MD, PT
Imaging and Ancillary Testing in Patients with Tandem Spinal Stenosis
John Metzler, MD
Spinal Masqueraders: Non-spine Conditions That Mimic Tandem Spinal Stenosis
Rick Placide, MD, PT
Interventional Management of the Patient with Tandem Spinal Stenosis
Allen Chen, MD
Surgical Management of the Patient with Tandem Spinal Stenosis
Sheng Fu Larry Lo, MD, MHS
Physical Rehabilitation of the Patient with Tandem Spinal Stenosis
Evan K. Johnson, DPT, OCS
Questions and Answers
Faculty Panel