If you’ve ever ridden a tandem bicycle, you know it’s trickier than riding a regular bike. You have two sets of arms, two sets of legs and two minds powering and steering the same bike. Riding one bicycle by yourself is easy; add another person, and nothing is straightforward.
A similar thing can happen in your spine when two different places are affected by spinal stenosis, a narrowing of the spinal canal. This is called tandem spinal stenosis, and much like riding a tandem bike, when there are two areas of stenosis in the spine, nothing is straightforward.
Dr. Evan Johnson, Director of Physical Therapy at The Spine Hospital at the Neurological Institute of New York, recently moderated a symposium on the challenges of diagnosing and treating tandem spinal stenosis.
The symposium was the opening event of the Interdisciplinary Spine Committee at this year’s North American Spine Society’s (NASS) annual Interdisciplinary Spine Forum, the world’s largest spine meeting and exhibition.
Spinal stenosis is caused by degeneration of the spine. It’s most common in adults over the age of 50, and it can be a significant source of disability. This degeneration causes the spinal canal to narrow and press on the spinal cord, causing symptoms like numbness, tingling, loss of motor control and pain. But in tandem spinal stenosis the narrowing occurs in more than one place, adding a layer of complexity, like another rider on the bike.
“This is a condition that is often misinterpreted and can be extremely challenging to diagnose and treat,” Dr. Johnson said to NASS 2017 Daily News. The problem is that symptoms of spinal stenosis are different depending on which part of the spine has narrowed.
When the spine narrows in more than one place you get a cluster of symptoms that fit a variety of different conditions, including motor-neuron diseases such as amyotrophic lateral sclerosis (ALS, or Lou Gehrig disease). Doctors have to work carefully to rule out these other conditions before the tandem stenosis can be diagnosed.
Dr. Johnson also discussed the importance of physical rehabilitation and education for patients who suffer from tandem spinal stenosis. Physical therapy can help identify and manage the symptoms of tandem spinal stenosis.
Once other conditions are ruled out, it can help maximize fitness and mobility before surgery, making recovery easier. And physical therapy after surgery helps the patient recover from the weakness and functional deficits caused by tandem spinal stenosis.
Success in diagnosing and treating tandem spinal stenosis at The Spine Hospital often depends on teamwork between physical therapists and surgeons. In fact, the NASS symposium included physical therapists, orthopedic surgeons and engineers, among other professionals.
“By bringing together experts in different disciplines,” Dr. Johnson said, “we hope to highlight the things we can do collectively that afford our patients with tandem spinal stenosis the greatest opportunity to heal and recover.”
• Dr. Evan Johnson Talks Hip and Back Pain at NASS Annual Meeting (2015)
• Dr. Evan Johnson Talks Back Pain Across a Lifetime (2014)
• PT Evan Johnson Speaking at North American Spine Society Meeting (2013)
• Dr. Evan Johnson Speaks at 2012 North American Spine Society Meeting (2012)
• PT Johnson Tests Strength and Balance at Annual NASS Meeting (2011)