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  • Thoracic Stenosis: Treatment and Outcome

    Final Number:

    Patrick W. Hitchon MD; Kingsley O. Abode-Iyamah MD; Nader S. Dahdaleh MD; Andrew James Grossbach MD; Hamdi Sukkarieh MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Thoracic stenosis is a severely disabling condition that is often missed. Unfortunately by the time the condition is diagnosed severe impairment has developed, and reversal is meager. For a good outcome early diagnosis is mandatory.

    Methods: Over the past 3 years we have encountered 13 patients with thoracic stenosis who have undergone operative intervention. Patients presented with varying degrees of myelopathy with sensory, motor, and sphincter disturbance. There were 3 women and 8 men, with a mean age+/- SD of 67+/- 12 years. Thoracic stenosis was diagnosed with MRI in 12 of the 13 patients, and with myelography in the last. Nine of 12 patients with MRI showed myelomalacia. Eight of the 13 patients had had previous spinal surgery. Patients were graded pre- and postoperatively with the ASIA impairment scale from A to E (1-5), and the Japanese orthopedic Association score for myelopathy (0-11).

    Results: All patients had a laminectomy for decompression and in 9 instrumentation and fusion when deemed necessary for instability. One patient who underwent laminectomy, had to undergo instrumentation and fusion for instability 6 months later. The preoperative ASIA and JOA scores were 3.8+/-0.7 and 5.8+/-2.5 respectively. At follow-up of 11+/-6 months, these values were 3.9+/-0.8 and 7.2+/-3.3 (p=0.79 and 0.24 respectively).

    Conclusions: Despite surgery, thoracic stenosis with deficit and myelomalacia on MRI is associated with minimal improvement. Thus early diagnosis with appropriate surgery is paramount for clinical improvement. Owing to instability, surgery in addition to decompression often necessitates instrumentation.

    Patient Care: This study will help in the diagnosis and treatment of thoracic stenosis.

    Learning Objectives: 1. Thoracic stenosis often present with spinal instability. 2. Early diagnosis and treatment of thoracic stenosis is paramount for improvement.


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