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16-MARCH-2008  ABDEL-QADER ISMAEEL MUHAMED  72 YEARS  SEVERE CERVICAL STENOSIS C2-3,3-4, 4-5, 5-6 AND MAXIMUM AT C5-6.

Anamnesis:

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The patient came to the clinic 08-March-2008 complaining of difficult walking for three years and inability to walk for 10 days with micturition problems for 15 years. The patient has decreased hearing left ear for 20 years.

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On examination: the patient came in wheelchair. Weak flexion and extension of both hands 2/5 and both triceps muscle 3/5. There is complete analgesia for pain brick below C7 with complete paraplegia below the same level.

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MRI lumbar spine done 15-July-2007 showed severe lumbar canal stenosis at  L4-5  with pelvis X-ray showing bony fusion of both hips.

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MRI cervical spine performed 08-March-2008  showing stenosis of the cervical spinal canal at C2-3, 3-4, 4-5 and C6-7, with maximum compression at C5-6 with malacia of the spinal cord.

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The patient is a known diabetic with prostate hypertrophy in omnic for 3 years.

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Decompressive laminectomy of C3-4-5-6 and 7  was done using the high speed drill. The epidural fat was absent at most of the levels. All compressing elements were eliminated. The most compressed part at C5-6 was decompressed last, to minimize the surgical trauma.

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Routine closure of the wound with smooth postoperative recovery.

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Slight recovery of the power of the upper limbs with no changes noted in the lower limbs.

Comments

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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.

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

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The patient has bony fused both hips, which means, that his paraplegia is more protracted as he claim. This kind of surgery will help him improve the power of the upper limbs, but recovery of the lower limbs is doubtful.

 

 


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