The prevalence and clinical characteristics of thoracic spinal stenosis: a systematic review
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REVIEW ARTICLE
The prevalence and clinical characteristics of thoracic spinal stenosis: a systematic review Guanghui Chen1 · Tianqi Fan1 · Xiaoxi Yang1 · Chuiguo Sun1 · Dongwei Fan1 · Zhongqiang Chen1 Received: 18 November 2019 / Revised: 14 June 2020 / Accepted: 21 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Thoracic spinal stenosis (TSS) is a rare disease secondary to multiple pathological changes that differ in prevalence and clinical characteristics. The epidemiological characteristics of these pathologies are largely unknown due to the limited case samples and regional differences. Therefore, a systematic review was conducted to elucidate the prevalence and clinical characteristics of TSS. Methods Case series and case reports on the ossification of the posterior longitudinal ligaments (OPLL), ossification of the ligamentum flavum (OLF) and thoracic disk herniation (TDH) were screened from PubMed, Embase and Web of Science databases and systematically reviewed. Epidemiological, demographic and segmental distribution data were extracted and analyzed. Results A total of 129 studies including 1935 subjects were selected, of which 361 (18.7%) were diagnosed with OPLL, 804 (41.5%) with OLF, 143 (7.4%) with OPLL + OLF and 627 (32.4%) with TDH. Most reports were from China, Japan and USA. Thoracic OPLL occurred mostly at the middle-thoracic spine (43.4%), while OLF predominately occurred at the lower-thoracic spine (63.1%). TDH was mainly localized in the middle (46.0%) and lower-thoracic (50.3%) spine. Thirtytwo studies involving 524 patients described tandem spinal stenosis, of which 52.1% had accompanying cervical diseases and 35.9% lumbar diseases. Conclusions There are significant differences in the age, sex and segment distribution characteristics of different pathologies leading to TSS. Tandem spinal stenosis is not uncommon and should be considered when diagnosing TSS. Our findings provide new insights into the prevalence and clinical characteristics of TSS and can help reduce misdiagnosis. Keywords Thoracic spinal stenosis · Ossification of the posterior longitudinal ligaments · Ossification of the ligamentum flavum · Thoracic disk herniation
Introduction Thoracic spinal stenosis (TSS) is a relatively rare disease characterized by narrowed spinal canal and compression of the spinal cord and/or nerve root. Although thoracic Guanghui Chen and Tianqi Fan have contributed equally to this work.
myelopathy caused by spinal stenosis is less common than that of cervical and lumbar spine [1], the outcome is relatively poor [2]. Several factors are responsible for the poor prognosis of TSS. The blood supply to the thoracic spinal cord is tenuous [3, 4], which makes it vulnerable to ischemic injury. Secondly, the thoracic spine is naturally kyphotic, which limits backward movement of the spinal
* Zhongqiang Chen [email protected]
Chuiguo Sun [email protected]
Guanghui Chen [email protected]
Dongwei Fan [email protected]
Tianqi Fan [email protected]
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