03-FEBRUARY-2025  ALI HUSSEIN ALI  38 YEARS HUGE EXTRUDED DISC C6-7 WITH BULGE C5-6 WITH RIGHT BROWN-SEQUARD SYNDROME.

The patient an Iraqi citizen came to the clinic 29-January-2025 in wheelchair, complaining of neck pain for 3 months.

On examination, the patient is in agonizing pain. Can walk with help of 2 persons, cannot be evaluated for Romberg stance. There is pain when turning the head to all directions, more to the right and down. There is hypalgesia of the left side of the face down to the left upper limb and analgesia of the right lower limb below the L1 root territory. Hoffman positive  in the right side and the deep tendon reflexes exaggerated in the left upper limb. There is weak grip left hand 4/5 and extension both hands 3/5 with left triceps muscle 4/5. SLRS was 10 degrees right side and 40 degrees left side without pain. There is weak right iliopsoas muscle, right quadriceps 3/5 and dorsiflexion right foot 4/5. Knee jerk exaggerated both sides, but Babinski and clonus negative both legs. Normal defecation and micturition , but los of libido for three months.

The patient was sent for investigations  and MRI brain and whole spine done 29-January-2025 showing very huge extruded disc C6-7 compressing the spinal cord with malacia of the spinal cord with bulge of C5-6.  There is retention cyst left to the sphenoid sinus and extrude disc L5-S1,

Using the C-arm, the level of C5-6 was identified and surgical exposure if both C5-6 and C6-7 was achieved.  Discectomy C6-7 was performed with meticulous cleaning until the dura was seen. Decompression of C5-6. Using the Coroent small interlock cage  7x17x14 mm dimension was inserted to both C5-6 and C6-7 disc spaces with S.I screws 4x14 to the C6-7 and the last to the C5  with length 15 mm to penetrate the C5 body.  Routine closure of the wound. The patient was sent to the ward.

Too early now.

Brown-Sequard syndrome (BSS) is a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis on one side of the body and a loss of sensation on the opposite side, but here, the loss of sensation and weakness are mostly is in the same side, which hold the atypical picture of anterior spinal artery involvement.