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18-AUGUST-2010  NADEEM SPER SALEH  60 YEARS  POST-TRAUMATIC SPONDYLOLISTHESIS WITH SEGMENTAL INSTABILITY OF C7-D1 AND MYELOPATHIC SYNDROME.

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 came to the clinic 07-August-2010 complaining of difficult walking and profound weakness both lower limbs after falling down 08-November-2009 in Saudi Arabia and was diagnosed and treated for polyradiculopathy with betaferon and prednisolone. The clinical course continued to deteriorate despite this modality of treatment.

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On examination: the patient walking with help. Romberg was not performed due to inability to stand. There is hypotrophy of interossii both hands with weak grip, extension of the hands and triceps both arms 4/5. There is analgesia below D3 left side and hypalgesia in the right side at the same level with dense anesthesia below the right knee. The right quadriceps is weak 3/5 and the left -4/5 adduction and abduction right knee 3/5 and left knee 4/5. The dorsi and planterflexion right foot -3/5 and left foot 3/5. SLRS was 60 degrees in the right due to weakness and 80 degrees in the left due to weakness. There is positive Babinski right side with hypotonia of the left foot.

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The patient was sent for MR investigations, which confirmed the presence of unstable spondylolisthesis of C7-D1 with compression of the spinal cord and malacia of the spinal cord at this level.

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Intradiscal decompression of C7-D1 with insertion of Fidji cage 17X12X6.9 mm to disc space after what the alignment of the dislocated bodies became more acceptable.  Trinica one level 22 mm length Trinica cervical plate was used with for 16 mm screws to achieve fusion of C7-D1. During tightening of the screws more reduction of the dislocated structures was noted. Routine closure of the wound.

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Smooth postoperative recovery and improvement of the power of four limbs with prompt normalization of the power of the upper limbs.


Comments

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The patient was treated empirically for polyradiculopathy without asking him about the history and without morphological examination for 9 months. MRI investigation of the whole CNS is mandatory to avoid such mistakes

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The stenosis and dislocation of C7-D1 caused spinal cord malacia and the MRI was performed in the supine position. The picture mostly will be more gloomy if the investigations were performed in the standing position.

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The repeated mechanical trauma was the cause of his progressive neurological deterioration.


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