The patient came to the clinic 26-January-2019 complaining of numbness thumb and index right hand for 2 months followed by feeling of warmness both lower legs with weakness and urgency and frequency.  MRI bad quality done 15-December-2018 showing severe cervical stenosis C3-4, C4-5 with spinal cord malacia at these levels. EMG  done 26-October-2018 telling bilateral CTS.

On examination: The power of right deltoid 3/5. right biceps 4/5. grip both hands 3/5, extension both hands 3/5, right triceps 2/5, left triceps 3/5. Weak dorsi and planterflexion right foot 4/5, right iliopsoas and right quadriceps femoris 4/5.Hoffman positive both sides. Babinski positive right side and suspected clonus right side.

The patient was sent for investigations and MRI cervical performed 26-January-2019 showing severe cervical canal stenosis C3-4, 4-5 with severe spinal cord compression and malacia of the spinal cord with segmental OPLL at these levels. Dynamic studies ruled out presence of overmobility. CT-scan confirming bony fusion of C3-4-5. Cardiac consultation was uneventful and B-core 2.5 mg prescribed once daily.

Decompressive laminectomy C3-4-5 was performed after drilling the laminae at the junction with the lateral masses. The patient was put in Reverse Trendelenburg position with Valsalva maneuver. No CSF leak. Routine closure of the wound.

Smooth postoperative recovery. The power of four limbs improved dramatically more the left side. He was sent to the ward.

The cervical canal stenosis when taking progressive course, the sooner the decompression the better the outcome.