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28-NOVEMBER-2017 MUSA ASSAD MUBARAK 70 YEARS
CERVICAL CANAL STENOSIS C3-4 WITH LESS AT C4-5.
The patient came to the clinic 21-November-2017
complaining of difficult walking for 1 years
with ataxic gait. His relatives came first
27-September-2017 telling that he he has
bilateral sciatica with "fainting attacks". MRI
lumbar spine performed 19-October-2016 showing
minimal spondylolisthesis L5-S1. Creatinine
Kinase was 2365 U/L and ESR was 30 mm/h. EMG
done 06-Novemebr-2016 demonstrating sensory
and motor axonal neuropathy. The patient in
Kuwait. The sons of the patient were advised to
be reevaluated there to rule out UMN disease.
The patient then came with MRI of the brain
performed 07-October-2017 showing mild brain
atrophy compatible with age. MRI of the cervical
spine showing as be extruded disc C3-4, 4-5 with
severe spinal cord compression and malacia of
the spinal cord at C3-4 level. There is
assimilation of C6+7. The patient is a
known diabetic for 20 years with arterial
hypertension for 10 years.
On examination; the patient is walking with help
and using crutches. There is weak both deltoid ,
biceps brachii 4/5. Flexion and extension both
hands -4/5 with the right hand weaker then the
left. Both triceps 3/5. The right quadriceps
muscle power -4/5, the left 4/5. Abduction of
the right Knee was 3/4, left -4/5. Adduction
both knees 4/5. Drop both feet with weak
planterflexion right foot -3/5 and left 4/5.
Sensation for pin-brick was normal. Hoffmann was
positive both sides with SLRS of the right side
60 degrees due weakness. The right KJ was
The patient was sent for investigation. MRI
whole spine was performed 22-November-2017 and
showed severe cervical stenosis C3-4 more
from the posterior elements with malacia of the
spinal cord and to lesser degree stenosis of the
C4-5. There is assimilation of C4-5-6. Dorsal
spine showed PDD D2-3. Lumbar spine showed
stenosis of L4-5
and L5-S1. Dynamic studies ruled out presence of
overmobility. ESR was 95 mm/h and CRP was 20
mg/L. Zinnat 500 mg twice daily was started and
the patient was sent for cardiac evaluation.
Skeletonization of lower part
ofC2, complete of C3,4 and upper part of C5.
Decompressive laminectomy of C3 and C4 was
performed after drilling of the bone until it
became transparent and started to bulge out by
itself. Routine closure of the
Smooth postoperative recovery. The power of
the upper limb normalized and dramatic
improvement of the lower limbs more the right,
except the long standing bilateral drop feet.
He was sent to the ward.
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.
The fist MRI showed as be the patient
needs anterior approach, but the last MRI confirmed that the
best option is posterior approach.