ArticleJournal of spine surgery (Hong Kong)2026
Early clinical outcomes of simultaneous biportal endoscopic decompression for tandem spinal stenosis: a single-center retrospective study.
Article in Journal of spine surgery (Hong Kong), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Tandem spinal stenosis (TSS), defined as simultaneous spinal canal narrowing at noncontiguous levels, most commonly involves the cervical and thoracolumbar regions and presents substantial challenges in surgical planning. Although staged decompression has traditionally been favored to reduce perioperative risk, simultaneous decompression may shorten overall treatment duration and accelerate neurological recovery. However, evidence regarding the safety and effectiveness of simultaneous minimally invasive decompression remains limited. Therefore, this study aimed to evaluate the feasibility and early clinical outcomes of simultaneous biportal endoscopic spine surgery (BESS) for TSS. Methods: This retrospective single-center case series included 11 patients with TSS who underwent simultaneous BESS between January 2024 and June 2025. All patients presented with cervical spondylotic myelopathy (CSM) accompanied by clinically significant lower-extremity neurological symptoms. Nine patients had concurrent lumbar radiculopathy, while two had additional thoracic spinal cord compression. Clinical outcomes were evaluated using the modified Japanese Orthopaedic Association (mJOA) score and Visual Analog Scale (VAS) for leg pain. Perioperative parameters and complications were recorded. Neurological recovery was assessed using the Hirabayashi recovery rate. Results: Simultaneous multiregional BESS decompression was successfully completed in all patients without conversion to open surgery. The mean follow-up duration was 10.2±2.7 months. Mean operative time and estimated blood loss were 307.7±48.5 minutes and 286.4±86.9 mL, respectively. No major perioperative complications, including dural tears, neurological deterioration, or surgical site infection, were observed. Significant clinical improvement was achieved, with mJOA scores improving from 9.9±1.1 preoperatively to 14.2±0.9 at final follow-up and VAS leg pain scores decreasing from 7.3±0.7 to 2.4±0.5 (both P<0.001). The mean Hirabayashi recovery rate was 52.9%±7.5%. Conclusions: Simultaneous BESS decompression appears to be a feasible minimally invasive approach for TSS, with encouraging short-term neurological improvement, highlighting its potential for broader application in complex spinal pathology.
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