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16-DECEMBER-2009  ABDEL-AMEER UTHMAN SHAMRAN 57 YEARS  SEVERE CERVICAL CANAL STENOSIS C5-6, C6-7. RESIDUAL AFTER ANTERIOR FUSION C4-5-6 3 YEARS AGO.

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Anamnesis:

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The patient was operated by me 28-December-2005 for severe compression of the cervical spine due to osteomyelitis of C5 with pathological fracture.

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The patient then came to the clinic 14-November-2009 complaining of LBP  with increased weakness of the left hand and the right foot with difficulty of walking.

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MRI of the lumbar spine performed 15-November-2009 showing PLD L1-2 and the cervical spine showing the deformed C4-5 but acceptable, with severe stenosis at C5-6 and C6-7 levels with malacia of the spinal cord at these levels. Dynamic studies ruled out presence of overmobility and solid fusion of C4 and C5.

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Decompressive laminectomy of C5-6-7 was achieved and check for instability was performed at all stages of the surgery. The epidural fat was absent at the decompressed levels and the dura became lax and free after the decompression. Check image-intensifier was used all the time.

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Routine closure of the wound. The power of the left hand and right foot immediately improved after surgery.


Comments

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The de novo stenosis could be the result of 2 elements evolving over the time: 1. Progression of osteoporosis, which led to compression of the spinal cord from behind, and 2. The stress of the movement of C4-5 was transferred to the below level, which led to gradual degeneration of the disc and triggered the stenosis anteriorly.

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Even the fused segment of C4-5 is ugly in visual inspection, but it is acceptable from functional estimation and causing no harm to the patient.

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The posterior fusion instrumentation was ready to be used, but the absence of instability, made this fusion meaningless.


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