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04-MARCH-2008  DR. ZUHEYR MUHAMED TAYEF  67 YEARS  SEVERE CERVICAL STENOSIS C3-4 WITH MALACIA OF THE SPINAL CORD DUE TO POSTERIOR ELEMENTS COMPRESSION.

Anamnesis:

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The patient came to the clinic 01-March-2008 complaining of limping for three months due to weak left lower limb associated with numbness both lower limbs. 10 days later got weak upper limbs with numbness more the left upper limb with mass reflexes of the left lower limb.

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MRI cervical spine done 17-February-2008 showing severe stenosis of the cervical spinal canal at C3-4 with the main compressive elements from the calcified hypertrophied ligamentum flavum with small bulge of C3-4 disc and malacia of the spinal cord at that level. MRI of the lumbar spine showed also LCS  at L4-5.

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On examination: the patient is dragging his left leg and has scoliotic stance. He has rheumatoid-like hands. The power of the deltoids 4/5 right and 4-/5  left, the biceps 4/5 both sides. The grip of both hands 5/5, but extensors of the hands 4/5. The triceps right 4+/5 and 4-/5 left side. There is hypalgesia of the median distribution of the right hand. Hoffmann sign is positive in the left with exaggerated deep reflexes both upper limbs more in the left. SLRS was 80 degrees in both sides. The patient had weak dorsiflexion right foot 4/5 and weak dorsiflexion right foot 3/5 and planterflexion same foot 4/5, and hypalgesia right L4-4-S1 territories.

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The patient was sent for MRI of the brain with contrast and MRA with MRV of the brain. The performed investigations ruled out the presence of other or associated causes of his problem.

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Laminectomy of C3-4 with partial of C2 and C5 was done, using the high-speed drill, so as not to violate the intralaminar structures by Smith-Kerrison or other devices. The bony cracks and the ligamenta flava were removed form the dura, which became relax, even before this moment.

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Special attention was given to the right junction of C3-4, which was drilled lateral up to the lateral mass.

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Routine closure of the wound and smooth postoperative recovery with normalization of the power of four limbs and recovery of sensation?.

Comments

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So as to avoid surgical trauma during decompressive laminectomy in cervical canal stenosis, using the high-speed drill with thinning of the bony structures, until they become paper-like thin and crack by themselves to regain relaxation and disappearance of compression. By doing that mechanical trauma becoming to zero. Special attention must be paid for constant irrigation, to avoid thermal injury.

 

 


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