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07-NOVEMBER-2017 SODA IYADA AL-RWELI 57 YEARS
EXTRUDED DISC C3-4 WITH SPINAL CORD COMPRESSION AND MALACIA OF THE SPINAL CORD.
The patient came to the clinic 22-February-2017
complaining of neck and LBP for 20 years with
exacerbation last year with bilateral sciatica.
MRI cervical spine performed 08-June-2015
showing huge PCD C3-4 with spinal cord
compression more to the left. MRI lumbar spine
showed bulge L4-5.
On examination, at that time, the patient is limping with
exaggerated scoliotic stance. SLRS was 45
degrees in the right with pain and 30 degrees in
the left with more pain. There is pain of the
neck when turning to all direction with
limitation when looking to the left. Biceps
brachii both sides 4/5, Grip and extension both
hands 4/5 weaker in the left. Both triceps -4/5.
Weak both quadriceps 4/5 and weak
dorsiflexion both feet 4/5 more weak in the
The patient was sent for investigations and
disappeared. She came 28-October-2017 with
deterioration of her condition with right
shoulder pain and left sciatica. MRI performed
25-May-2017 showing the same huge extrusion of
C3-4 with bulge L3-4, L4-5 and L5-S1.
On examination; the weakness slightly
deteriorated with hypalgesia left shoulder, and
right upper limb below the shoulder and
hypalgesia of the entire right leg.
The patient was sent for investigation. MRI of
the cervical spine performed 28-October-2017
showing the same extrusion with malacia of the
spinal cord. MRI lumbar spine showed bilge L4-5
with stenosis. Dynamic studies showed I degree
Transnasal intubation. Projection incision over C3-4
was created and discectomy of C3-4 was achieved
until the dura was seen all over the posterior
aspect of the disc space. Epidural
bleeding took place from the left upper corner,
which was controlled by positioning the patient
with the head above the heart level. ON PLUS
CERVICAL BLADED CAGE 13X15 H7 IN'OS bone graft
were inserted to the disc space and control
C-arm showed acceptable positioning.
Routine closure of the
Smooth postoperative recovery. The power of
four limbs became better.
She was sent to the ward.
The patient has huge extruded disc
compressing the spinal cord with progressive clinical
deterioration. Decompression of the spinal cord is the only
solution to prevent further deterioration.