Tandem Spinal Stenosis: Chiropractic Clinical Management
Review written by: James Demetrious, DC, DABCO
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In a recent article published in the Journal of the American Academy of Orthopedic Surgeons, Baker offers insight into the evaluation and treatment of Tandem Spinal Stenosis (TSS): J Am Acad Orthop Surg 2020;28: 229-239.
The author reports that TSS is defined as stenosis affecting two or more non-contiguous anatomic regions of the spine. Due to the constellation of symptoms stemming from TSS, clinicians may have trouble managing these cases.
The nuanced symptoms and signs stemming from multiple stenotic regions complicate the clinical presentation. The presence of upper or lower motor neuron lesions are important determinants regarding care and planning.
Non-surgical and surgical treatment modalities should be considered. A stepwise progression of clinical options and a staged approach of care is wise. Careful assessment of co-morbidities is essential. Baker recommends that treatment precedence should be given to address most proximal stenosis first unless more caudal disease predominates.
The need for surgical consultation requires careful historic evaluation, examination and follow up to determine the progression of symptomatic disease processes. Careful assessment of co-morbidities is necessary.
In practice, chiropractic doctors provide care to TSS patients with favorable outcomes. Spinal stenosis as a progressive, degenerative condition. Intermittent exacerbative incidents do occur. Chiropractic care should be administered with regular assessments to alleviate suffering and restore function in a progressive manner, when possible.
From a risk management perspective, spinal stenosis requires nuanced understanding and advanced training related to the potential for indications of care and the need for surgical interventions.
Advanced training is vital toward differential diagnosis, indications and contraindications, careful assessment of imaging findings and comprehensive awareness of integrative modalities of assessment and care that may benefit patients.
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