The patient came to the clinic 28-January-2014 complaining of inability to move the four limbs for 4 years with left sciatica with deterioration the last 6 months. He underwent laminectomy L4-5 in UK 1977. Cardiac cath done 2010.

On examination; the patient is limping and dragging the left leg with exaggerated scoliotic stance. He has hypotrophy of both interossii muscles both hands. The grip of both hands 5/5, extension both hands 4/5. Triceps both upper limbs -3/5. Quadriceps both lower limbs 5/5, dorsiflexion left foot 0/5, right foot 4/5, dorsiflexion right foot 4/5 planterflexion left foot -4/5. SLRS was 80 degrees without pain both sides.

The patient sent for MRI of the brain, cervical, lumbar and dynamic X-ray of the lumbar spine and done 28-January-2014 showing the small scattered lacunar infarctions of both cerebral hemisphere. MRI cervical spine showed severe cervical canal stenosis at C3-4, C5-6 and C6-7 levels with more compression from the posterior elements with malacia of the spinal cord. There is  assimilation of C4 and C5. MRI lumbar spine showing lumbar canal stenosis at L1-2, 2-3, 3-4 and L4-5.

Decompressive laminectomy of C3,4,5,6 and upper 1/3 of C7 with preservation of the spinous process of C7. There was no epidural fat. Routine closure of the wound.

Smooth postoperative recovery. The patient showed dramatic improvement of the power of four limbs. 

The patient has progressive cervical canal stenosis. The sooner the surgical intervention, the better the postoperative outcome.

When there is stenosis of the cervical and lumbar spine, the cervical pathology take precedence in surgical treatment.