Our Summary

This study looked at a special type of surgery called muscle-preserving selective laminectomy, which is done to treat conditions of the neck (cervical disorders). They specifically examined a rare condition that can occur after this surgery – atlantoaxial stenosis, which is a narrowing of the space in the upper part of the spine.

They compared 1,205 patients who had the surgery, including four who developed this stenosis, and 30 who didn’t show any signs of stenosis even 10 years after surgery. They also included 20 healthy people with no neck disorders for comparison.

They measured a number of different variables in the spine, both before and after surgery, and also looked at the size of the spinal cord and the surrounding protective layer, the dura, at a specific point in the neck (C1/C2).

They found that in patients who developed stenosis, the spinal cord and dura at C1/C2 were smaller before surgery, and the space left for the spinal cord was also smaller. They also found that these patients had a higher pre-surgery measurement called the ADI, which could suggest instability at this point in the spine.

In analyzing the data, they found that patients with a certain combination of these measurements - a space for the spinal cord of less than 3.6 mm and an ADI of more than 1.35 mm - were more likely to develop stenosis after surgery.

Based on these findings, the researchers suggest that when doing this type of surgery, the surgeon should also perform a decompression at C1/C2 (a procedure to relieve pressure) if the patient’s measurements fall into this range.

FAQs

  1. What is atlantoaxial stenosis and how does it relate to muscle-preserving selective laminectomy?
  2. What are the key radiographic parameters measured in patients undergoing muscle-preserving selective laminectomy?
  3. How can a surgeon determine if a patient is at risk of developing postoperative atlantoaxial stenosis following a muscle-preserving selective laminectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about spinal laminectomy is to be aware of the potential risk of developing atlantoaxial stenosis after the procedure. Patients should be monitored for symptoms such as neck pain, numbness or weakness in the arms or legs, and difficulty with balance or coordination. It is important to follow up with your doctor regularly and report any new or worsening symptoms promptly. Additionally, patients with certain preoperative risk factors, such as a smaller spinal cord diameter at C1/C2 or a higher atlantodental interval, may be at a higher risk for developing postoperative stenosis and should be closely monitored.

Suitable For

Patients who are typically recommended spinal laminectomy include those with cervical disorders such as degenerative atlantoaxial stenosis and new stenosis after cervical decompression. In particular, patients with preoperative instability at C1/C2, as indicated by a high atlantodental interval (ADI) and a small residual space for the spinal cord (SAC), may benefit from selective laminectomy to decompress the affected area. Additionally, patients with a SAC of less than 3.6 mm and an ADI of more than 1.35 mm may be at higher risk for developing postoperative atlantoaxial stenosis and may require decompression at C1/C2. Overall, careful evaluation of radiographic parameters and patient-specific factors is important in determining the appropriate candidates for spinal laminectomy.

Timeline

  • Before spinal laminectomy: Patients may experience symptoms such as neck pain, numbness or weakness in the arms or hands, difficulty walking, and bladder or bowel dysfunction. They may undergo diagnostic tests such as X-rays, MRI, or CT scans to determine the cause of their symptoms.

  • During spinal laminectomy: The surgical procedure involves removing a portion of the lamina (the bony arch of the vertebra) to relieve pressure on the spinal cord or nerves. The surgery is typically performed under general anesthesia and can take a few hours to complete.

  • After spinal laminectomy: Patients may experience pain and discomfort at the surgical site, as well as temporary weakness or numbness in the affected areas. Physical therapy and rehabilitation may be recommended to help improve strength and mobility. In some cases, patients may develop complications such as infection, bleeding, or spinal fluid leakage. Long-term follow-up is necessary to monitor for any signs of new stenosis or other issues that may arise.

What to Ask Your Doctor

  1. What is the likelihood of developing atlantoaxial stenosis after undergoing a spinal laminectomy?
  2. How can I prevent or minimize the risk of developing postoperative atlantoaxial stenosis?
  3. What are the signs and symptoms of atlantoaxial stenosis that I should watch out for after the surgery?
  4. How will the development of atlantoaxial stenosis affect my overall spinal health and mobility?
  5. What treatment options are available if atlantoaxial stenosis does occur after the spinal laminectomy?
  6. How often should I have follow-up appointments and imaging studies to monitor for any signs of atlantoaxial stenosis?
  7. Are there any lifestyle modifications or physical therapy exercises that can help prevent or manage atlantoaxial stenosis after the surgery?
  8. Are there any specific factors or conditions that may increase my risk of developing atlantoaxial stenosis after the spinal laminectomy?
  9. What is the typical recovery process and timeline for patients who develop postoperative atlantoaxial stenosis?
  10. Are there any alternative surgical techniques or procedures that may reduce the risk of atlantoaxial stenosis in my case?

Reference

Authors: Aoyama R, Yamane J, Ninomiya K, Takahashi Y, Kitamura K, Nori S, Suzuki S, Matsumoto S, Kato M, Ueda S, Anazawa U, Shiraishi T. Journal: J Clin Neurosci. 2022 Jun;100:124-130. doi: 10.1016/j.jocn.2022.04.013. Epub 2022 Apr 19. PMID: 35453100