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16-FEBRUARY-2017 AHMAD AZHAR MAHMOUD 52 YEARS
EXTRUDED HUGE DISC C4-5, C5-6 AND TO LESSER DEGREE THE C6-7MORE TO THE RIGHT
WITH MALACIA OF THE SPINAL CORD WITH RIGHT BROWN-SEQUARD SYNDROME.
The patient's relatives came to the clinic
complaining of inability to walk for 12 months.
They mentioned that he has profound weakness of
the right upper and lower limbs. MRI of the
brain showed scattered infractions of no
significance with MRI of the cervical spine
showing huge extruded disc C4-5, C5-6 and to
lesser degree the C6-7. The extrusions were more
in the right side with malacia of the spinal at
these levels. There is OPLL at these levels. The
patient has arterial hypertension for 2 years,
under treatment. The patient is deteriorating
gradually with difficult of urination for 16 months
and difficult defection
the last 10 days.
On examination during admission, the patient can
walk with walker with difficulty, the grip of
the right hand 2/5, the left hand 4/5. extension
right hand 2/5, left hand 3/5, triceps both arms
3/5, weak dorsiflexion right foot 3/5, left foot
4/5, planterflexion right foot 4/5, left foot
5/5. There is hypalgesia left lower limb.
Hoffmann positive both sides. Babinski positive
both sides with brisk clonus both lower limbs.
Discectomy C4-5 and C5-6
until the dura was seen in the entire posterior
aspect. 2 cages CFRP 6 standard with bone graft
ATLANTIK Genta were inserted to the disc spaces.
Skyline plate 38 mm with 2 fixed screws 14 mm to
C5 and 4 variable screws 16 mm to C4 and C6 were
used to fuse C4-5-6. Routine closure of the
Smooth postoperative recovery. The power of
four limbs dramatically improved after recovery and he was sent to the ward.
The patient the same day after several hours
regained full power of all extremities and and
the next day telling the sensation in the left
leg has returned and urination normalized. This
dramatic postoperative recovery is not the rule
after such surgery.
The patient is deteriorating and surgical
decompression associated with long run medications is the