The patient came to the clinic 13-March-2008 complaining of neck pain and ataxia and fainting attacks for 25 years. Cervical X-ray done 1994 showed dislocated C4-5. The last 2 months, he had left sided headache.

MRI cervical spine performed 04-March-2008 showed kinking of the spinal cord at C3-4 with stenosis at this level and C4-5 , mainly from posterior elements. MRI of the brain was normal.

On examination: Romberg test was negative. Weak right deltoid and right biceps brachii and extension both hands  and the right triceps muscle. He had also weak dorsiflexion both feet and planterflexion right foot. and right quadriceps muscle. There was no sensory deficit, nor pathological reflexes.

The patient was sent for simple X-ray of the cervical spine with extension and flexion, which confirmed the bony fusion of C3 and C4 bodies.

The patient is a known hypertensive with hypoten 50 mg per day and in baby aspirin.

Decompressive laminectomy of C3-4 and 5  was done using the high speed drill. The epidural fat was absent at these levels. All compressing elements were eliminated. The most compressed part at C3-4 was decompressed last in the right side, to minimize the surgical trauma.

Routine closure of the wound with smooth postoperative recovery.

Dramatic recovery of the power of the upper limbs and the lower limbs.

Posterior decompression of the cervical spine in CCS seems to be more acceptable than the anterior approaches, using the new modifications with the high-speed drilling. By this method surgical trauma becoming to zero.

In the past, posterior decompression was associated with lot of complications due to surgical trauma by using the Smith-kerrisons and so on instrumentations.

The patient has bony fused C3 and C4, which could be after some inflammatory process with old spondylolisthesis of C3-4. But the disc space is very narrow and the bodies are fused. The main compressing elements were arising from the posterior elements. From anterior approach the patient mostly will not benefit and the comparative ease and effectiveness of the posterior approach made the posterior decompression, the appropriate solution for his problem.