The patient was operated for cervical canal stenosis 1996 for
progressive quadriparesis. Posterior approach with laminectomy C3
down to C7 was performed and the patient improved.
began to deteriorate 2004, when he started to complain of neck pain
and progressive quadriparesis with inability to walk and severe
weakness of the right upper limb and both lower limbs.
MRI performed showing malacia of the spinal cord and
syringomyelia with severe stenosis and compression at several levels
more at C3-4 with inverted curvature of the cervical vertebral
Considering that the patient has severe stenosis especially at
C3-4 level, it was decided to perform posterior redecompression. The
patient was put in supine position and posterior approach was
performed and all the bony compressing elements were eliminated.
Duralysis was performed circumferentially after what, the dura
regained relaxed appearance.
During surgery, severe overmobility of the cervical segments was
noted and it was noted that the lateral masses are tiny, not
standing for posterior fusion, for what, the wound was closed and
anterior approach was performed and anterior fusion of C3-7 was
performed with mild binding, resembling the normal curvature of
normal cervical column. The C4-5-and 6 came up and rigid fixation
with acceptable alignment was achieved. Routine closure with smooth
1. In this case, direct anterior fusion without inspecting the
posterior elements and decompressing all the bony parts, especially
at C3-4 could result in further trauma to spinal cord and disturbed
respiratory drive, for what it was logical to perform posterior
exploration and decompression.
2. Posterior fusion was impossible, because his lateral masses
were tiny, not withstanding the construct for posterior fusion,
further more to regain the normal curvature of his inverted
3. Anterior fusion, after securing the spinal cord from behind,
gave excellent reduction of his inverted curvature, which was beside
overmobility, the determinant cause of his chronic damaging factor
to his spinal cord.