Dear editor,


We read the article “Primary cervical decompression surgery may improve lumbar symptoms in patients with tandem spinal stenosis” by Inoue T, et al. [1] with great interest and had a long deliberation and appraisal on the different aspects discussed in the concerned article. At the go, we congratulate the authors for selecting a retrospective analysis of a common combination of stenosis, but scarcely described in literature.

Certain significant points of concern which need redressal are:

  1. 1.

    Any specific reason/reasons mentioned and analysed in the literature to conduct myelography and computed tomography for all patients with LSS to evaluate the cervical lesion and the lumbar spine; MRI in one go would have been the diagnostic modality of choice, all the more non-invasive.

  2. 2.

    Reason for the proportion of males in the relapsed group being higher than the non-improved group and the finding of no significant difference in terms of sex between the non-improved and maintained-improvement groups.

  3. 3.

    Is this retrospective study with only 14 subjects maintaining improvement in LSS symptoms following cervical decompression in a total Japanese cohort of 64 only, worth recommending for the surgeons worldwide?