For a study, the researchers helped investigate the diagnosis and surgery strategy for the treatment of the development of spinal canal stenosis (DSSA) at an atlas plane based on computerized tomography (CT) image characters. There are type I 7, type II 3, type III 2, and group IV 3 in the 15 cases. Patients received different surgery procedures respectively: (1) posterior arch osteotomy was performed for group I/III//IV without atlantoaxial dislocation, (2) posterior arch resect and replantation was done for group II, (3) occipital cervical fixation and fusion was added to the patients with related atlantoaxial dislocation (AAD), (4) a new method of odontoid reduce and atlantoaxial fixation by transoral approach was done for group IV with related AAD. All cases underwent surgery successfully, which included posterior occipitocervical fixation (OCF) + posterior arch resection (PAR) 8 cases, PAR 4 cases, posterior arch remodeling and re-implantation (PARR) 2 cases, and Dens remodeling + trans-oral anterior reduction and plate fixation (DR+TARP) 1 case without severe complications. All patients showed further progress in the symptoms. DSSA can be easily diagnosed and divided into 4 subgroups according to the character of the CT image; the corresponding surgery strategy could receive a satisfactory clinical result.