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Dr. Ali Al-Bayyati and Dr. Munir Elias

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16-MARCH-2013  NASER ABDALLA AL-MOMANY  79 YEARS  SEVERE CERVICAL STENOSIS C3-4, 4-5 AND 5-6 WITH RADICULO-MYELOPATHIC SYNDROME.

 

Anamnesis

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The patient came to the clinic 18-February-2013 complaining of severe weak four limbs after falling down 40 days ago with feeling numbness both hands with difficult moving of the hands and right shoulder pain radiating to the right upper limb.

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MRI cervical spine done 16-January-2013 showing severe cervical canal stenosis C3-4 with malacia of the spinal cord at his level and stenosis to lesser degree at C4-5 and C5-6 levels.

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On examination: The patient is standing and walking with help. There is weak both deltoid muscles -4/5, both biceps brachii -3/5 more weak at the right side and 2/5 grip both hands and 1/5  extension left hand and 0/5 right hand and 2/5 of the right triceps muscle right upper limb with good power of the left. There is weak dorsiflexion both feet -4/5 more the left. Hypalgesia both hands.  Hoffmann positive both sides more brisk in the right  with exaggerated deep reflexes all over.

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Decompressive laminectomy C3,4,5 and upper half of C6. The ligamentum flavum at C2-3 was calcified, for what it was drilled out. The epidural fat was missing all over due to severe compression. The dura start to show good cardio-pulmonary pulsation.

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Routine closure of the wound. Smooth postoperative recovery. The power of the feet became normal. The upper limbs still the same.

 

 

Comments

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The trauma triggered the pathology, but the stenosis when severe is a source of repetitive trauma, which must be eliminated.

 

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Notice: Not all operative activities can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also escaped from the plan .

  

 

 

 

 

 

 

 

 

 

 

 

 

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