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29-NOVEMBER-2017 AHMAD SAAD RAHAHLEH 51 YEARS
EXTRUDED DISC C4-5, C5-6 WITH MALACIA OF THE SPINAL CORD AT C5-6 WITH MORE
COMPRESSION FROM THE RIGHT.
The patient came to the clinic 20-November-2017
complaining of numbness of the right upper and
lower limbs, more from the right nipple downward
for 7 years with numbness both hands. MRI
cervical spine performed 08-November-2017
showing extruded disc C4-5, C5-6 with spinal
cord compression more from the right side with
malacia of the spinal cord at the C5-6 level.
Lumbar MRI showed bulge L4-5 and L5-S1.
On examination; the patient is not limping now,
with weak extension of the hands and triceps
both arms 4/5. Hoffmann positive both sides.
There is hypalgesia for pin brick from 10 cm
above the right nipple right side.
The patient was sent for investigation and
Discectomy C4-5 and C5-6
until the dura was seen at both levels.
Osteophytectomy of the C5-6 level. Cervical
cages 7 x05 inserted to both levels. Using
Precision Spine ACDF 46 mm 2 level with 4
variable 4x16 mm to C4 and C6 and 2 fixed same
dimensions to C5 were used to fix C4-5-6. Routine closure of the
recovery. The power of the right upper limb
normalized. The power of the left hand and left
leg deteriorated immediately after surgery. He was sent to the ward.
The patient showed full blown left sided
Brown-Sequard syndrome, which over several hours
started to recover. Control MRI done at 9.00
p.m. showed no compression and the spinal cord
hanging free with the previous malacia, which
will be morphologically permanent. The next day,
the patient could walk with help and could move
the upper and lower limbs. It was explained to
the patient that, this phenomena can happen and
it needs days to fully recover, but the sensory
deficit, will partially recover over the years.
The patient having severe stenosis of the
cervical spine with malacia of the spinal cord with
progressive deterioration. Surgical decompression is the
best solution to prevent further deterioration.
Here the compression is from anterior,
for what anterior approach is performed.