Introduction: The present study aimed to understand the characteristics of adjacent segment stenosis post-surgery by examining the status of adjacent segment stenosis in patients with long-term follow-up after muscle-preserving selective laminectomy (SL). Methods: We examined 43 patients who underwent muscle-preserving SL at a single academic institution and were followed up for >10 years. The C2-C7 angle, C2-C7 sagittal vertical axis, range of motion, and C7 slope were measured using an X-ray lateral view. The anterior-posterior diameter of the spinal cord (AP of SC) and anterior-posterior diameter of the dural tube (AP of dura) at adjacent segment were measured using magnetic resonance imaging T2-weighted sagittal section. Residual space for the spinal cord at the adjacent segment (SAC) was calculated as the difference between AP of SC and AP of dura. Results: Four cases had cephalad adjacent segment stenosis at the last follow-up (upper stenosis (US) group), 9 cases had caudal adjacent segment stenosis ( lower stenosis (LS) group), and 30 cases had no stenosis (none (N) group). AP of SC, AP of dura, and SAC at the upper adjacent segment were significantly lower in the US group. AP of dura and SAC at the lower adjacent segment were significantly lower in the LS group. Multivariate logistic regression analysis revealed that the small AP of dura in the upper adjacent segment and small SAC in the lower adjacent segment were risk factors for developing a new stenosis. Conclusions: Decompression should be considered beforehand in adjacent segments with small AP of SC and small AP of dura when performing cervical decompression.
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