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24-DECEMBER-2017 NAEL SAEED AL-NAJJAR 34 YEARS
HUGE EXTRUDED DISC C4-5 WITH SEVERE SPINAL CORD COMPRESSION AND MALACIA OF THE
The patient came to the clinic 20-December-2017
complaining of numbness four limbs
for 3 weeks. Bad MRI
cervical spine performed 17-December-2017
showing huge extruded disc C4-5, C6-7 with spinal
cord compression more from the right side with
malacia of the spinal cord at the C4-5 level.
On examination; the patient is limping,
with weak extension of the right biceps 4/5,
both hands flexion -4/5, extension hands -3/5
with inability to extend both hands fingers and triceps
both arms 3/5. Hoffmann positive both sides.
There is hypalgesia for pin brick below both L2
roots territories. There is weak dorsi and
planterflexion both feet 4/5, more week at
the right. SLRS was 60 degrees both sides with
weak right quadriceps, The deep reflexes are
exaggerated in the right side with Hoffmann
signs positive both sides and Babinski positive
in the right. There clonus both feet more brisk
at the right.
The patient was sent for investigation and
proper MRI done 20-December-2017 showing huge
extrude disc C4-5 with bilateral compression of
the spinal cord, more the right and an old
calcified extrusion C6-7 left side. Dynamic
studies were normal and CT-scan of the cervical
spine showed the ossification of C6-7 left side.
Discectomy C4-5 until the dura was seen at both
sides. ON PLUS (EOS) Cervical
bladed cage 14x17 H7 with IN'OSS 2x0.5 ml inserted to C4-5 level. Routine closure of the
recovery. The power of four limbs improved
dramatically. He was sent to the ward.
The patient having severe stenosis of the
cervical spine with malacia of the spinal cord with
sudden onset deterioration the last 3 weeks. Surgical decompression
of C4-5 is the
best solution to prevent further deterioration and the old
calcified extrusion of C6-7 was left untouched.
Here the compression is from anterior,
for what anterior approach is performed.