Evaluation and Treatment of Tandem Spinal Stenosis For stenosis of the cervical spine, judicious decision making is required. The natural history of CSM is one of stepwise progression—surgical intervention does not necessarily lead to reversal of the deficit, and so, any delay in surgery exposes the patient to potentially further loss of function. Systematic reviews have failed to find quality evidence to support nonsurgical treatment in CSM—of those managed nonoperatively, a notable number (more than 50% on one review) eventually undergo surgical intervention.24 In patients initially managed nonoperatively, a higher rate of hospitalization for spinal cord injury is also seen.25"
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