Transient breathing disorders after posterior cervical surgery for degenerative diseases: pathophysiological interpretation

Central sleep apnea is a breathing disorder that manifests as repetitive cessation of the breath during the sleep. The occurrence of breathing disorders after cervical laminectomy has been exceptionally described as a complication after cervical decompressive laminectomy for cervical stenotic myelopathy. In 1994, Naim-ur-Rahman reported the first case of postoperative central sleep apnea following C3-C6 laminectomy, occurring right after surgery and associated with spyncterial incontinence, that spontaneously recovered three weeks after onset. Recently we described a rare complication of cervical laminectomy for cervical stenotic myelopathy: the onset was delayed from surgery (nearly two weeks later) and cervical stenotic myelopathy was not associated to any other neurological sign of spinal cord damage as demonstrated by the neurophysiological assessment. Possible familiar predisposition can be matter of discussion. No definite interpretation of pathophysiological mechanisms can ultimately explain the occurrence of delayed and isolated central sleep apnea after laminectomy for the treatment of cervical stenotic myelopathy. Such a reversible and benign complication remain unpredictable in the best surgical hands.