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29-APRIL-2010  HUSNI HAMED AHMAD  70 YEARS  SEVERE CERVICAL CANAL STENOSIS C3-4 AND C4-5.

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 19-July-2007 for PCD C4-5, C5-6 and C6-7 with subsequent fusion of C4 down to D1.

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The patient is a known diabetic with glaucoma both eyes with arterial hypertension.

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The patient then came 02-July-2009 with LBP and left sciatica  with MRI lumbar spine performed 29-June-2009 showing lumbar canal stenosis L2-3 and L3-4. There was weak dorsiflexion right foot 4/5 and left foot -4/5. The patient was treated conservatively.

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The patient then came 25-March-2010 complaining of numbness of the neck and right shoulder, which disappear when using the collar. He was also complaining of bilateral sciatica. The patient is claiming that his condition is deteriorating, but the weakness of both feet still the same.

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MRI cervical spine performed 04-April-2010 showed severe stenosis of C3-4 and C4-5 more from the posterior elements.

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The patient has glaucoma both eyes for what acetazolamide was started one day before the surgery to prevent ocular complications from the operative positioning.

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Using MEP-SEP Inomed highline IOM after careful intubation, the patient was positioned to laminectomy position with slight flexion. N20 and P40 were delayed from the start in the left side. Decompressive laminectomy C3-4-5 and partial of C2 was done. Drilling of the bone was achieved, so that zero surgical trauma was applied to the stenotic parts. There was no epidural fat at the entire of the exposure. 2 mm medial to the lateral masses were lift untouched. The IOM data were the same all the time. Routine closure of the wound.

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Smooth postoperative recovery with no complications.


Comments

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The patient  had previously stenotic canal from anterior for what anterior decompression was done with fusion of the cervical spine from C4 down to D1.  The age and the transfer of the stress points to the above levels with slight osteoporosis were the result of such stenosis.

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Cervical canal stenosis is progressive disease and when it clinically progressing surgical interference is the appropriate solution.

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Great care was applied to the glaucoma and the neurological status of the patient to prevent catastrophic sequel  when dealing with such case.


Back Up!

Notice: Not all operative activities can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also escaped from the plan .

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