The patient came to the clinic 27-November-2006 complaining of
neck pain for 2 years with right upper limb pain with spastic
quadriparesis last 2 months with ataxic gait. MRI cervical spine
performed 3 years ago showed stenosis at C4-5 level without malacia
of the spinal cord.
On examination: the patient walking with help
Dupuytren's disease with OA both knees and frozen right
shoulder. The patient had hypalgesia of the radial side of the
forearm and severe weak right arm. The patient was sent for MRI of
the brain with MRA of the brain and carotids and MRI of the cervical
spine with MR Myelography, which was performed 29-November-2006
confirming the escalation of his cervical canal stenosis at C4-5 and
C5-6 with malacia of the spinal cord at the C4-5 level.
Discectomy of both C4-5 and C5-6 was performed with complete
decompression of the dura at the C4-5 level and fixation of C4-5-6
using Stryker brand of miniplates and screws. The ossified anterior
edges of the C4 were nibbled to have the construct fitting in
acceptable position. Smooth postoperative course.
1. CCS is a progressive disease and when the patient start to
have progressive neurologic deterioration, surgery must be performed
to prevent further deterioration.
2. Anterior decompression is superior than posterior
decompression, when the compressing agents are located anteriorly,
as in this case. If decompression was performed at one level then
fixation is not needed, but when multilevel decompression is
performed, then fixation must follow.