The patient came to the clinic 16-January complaining of sudden onset neck pain 02-December-2007, after what he got weak both upper limbs. The lower limbs remained in good condition.

MRI cervical spine performed 12-December-2007 showed severe cervical canal stenosis at C3-4, 4-5 and C5-6 with malacia of the spinal cord with the major compression from behind.

On examination: the power of both deltoids and biceps brachii and the grip of both hands were 4/5. The extension of both hands and the triceps muscles were 3/5. The sensation and the power of the lower limbs were intact.

Considering that the major compressing elements were from behind, posterior decompression was performed. The decompression was modified, that the Laminae of C3-4-5 and 6 and lower 3/4 of the C2 were drilled in such a way, that after removal of the spinous processii, drilling was performed far-lateral of the laminae abutting to the lateral masses until the laminae were flail. The C3-4 and C4-5 compressing elements were eliminated, which were bony and ligamentum flavum material. Midline drilling was performed to be sure that the laminae were were hanging free. We will call this procedure a trilinear decompression of the posterior cervical spine.

Routine closure of the wound and smooth postoperative recovery.

In cervical canal stenosis anterior decompression with fixation is the preferred method, but when the compressing elements originate from behind, posterior decompression is the only solution remains.

Traditional posterior decompression in cervical canal stenosis usually causes dramatic deterioration of the patient. To avoid such events modifications of the decompression, to minimize the surgical trauma to the already compressed spinal cord are applied with the use of the high-speed drilling. This presented modification bring the mechanical and thermal injury to the cervical spine to zero.