The patient came to the clinic 18-December-2017 complaining of right sciatica, edema and coldness both lower limbs and difficult walking for 5 years. Using walker for 2 years. Reported as having stroke 13-October-2017 with un-informative CT-scan done at that time. The patient is a known diabetic for 20 ears and hypertensive for 15 years and hypothyroid under treatment.

On examination, the patient using walker for ambulation.  There is hypalgesia of the right foreleg and both feet. The right deltoid is 3/5, left 4/5. The biceps right arm is -3/5, left side 4/5, flexion of the hands 4/5, extension both hands 3/5, triceps 3/5. The quadriceps femoris both lower limbs 4/5, dorsiflexion right foot 3/5, left foot 0/5. The planterflexion right foot 4/5 and left foot 4/5. Hoffmann positive both sides and Babinski negative. SLRS was 70 degrees both sides. Edema both lower limbs.

The patient was sent for investigations. MRI cervical spine performed 07-January-2018 showing severe cervical canal stenosis C4-5. 5-6 with malacia of the spinal cord. Dynamic studies ruled out overmobility. MRI dorsal spine showed bulge D8-9. There is severe LCS L4-5 with spondylolisthesis L4-5. The patient was sent for cardio evaluation and anticoagulants stopped for 1 week before surgery.

Decompressive laminectomy C3,4,5 and C6 was achieved without violating the extradural space. The dura became bulged and transparent. Routine closure of the wound.

Smooth postoperative recovery. The power of the four limbs with slight improvement. The left drop foot the same. He was sent to the ward.

The clinical course is deteriorating. At least decompression will halt this deterioration.

The patient has several problems, but the cervical spine take precedence in the management.