The patient came to the clinic in wheelchair with quadriparesis below the level of C4 with urinary and defecation problems. MRI done showing severe cervical canal stenosis C3-4,4-5 with instability of C4-5. The patient is a known hypertensive for 7 years and insulin-dependent diabetic  for 16 years with cardiac problems, for what he is in isokit, moduretic, and bufferin.

Through anterior approach discectomy of C3-4 and C4-5 was performed and fusion of C3-4-5 was achieved. Smooth recovery and the patient sent to the ward. The power of 4 limbs improved.

The patient came to the clinic after surgery 08-May-2005 with considerable improvement of the power of all limbs and he was advised to come another time with new check cervical X-ray. He had weak extension of the right hand 4/5 and hypalgesia of the right foot and the left foreleg.

The patient escaped the follow-up, and as I understood he progressed 2 months later pulmonary oedema and died later.

In high-risky patients such in this case, careful perioperative monitoring of the general condition, avoid the patient of possible disastrous events in the perioperative period. It is more important to tell the relatives to put the patient in more careful monitoring for protracted period of time, because in the case, that the patient is neurologically improving, he is becoming more active, with subsequent escalation of his cardio-pulmonary problems, which could end with disaster, as in this case.