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10-SEPTEMBER-2025
AMNEH MAHMOUD ABDALLAH 70 YEARS SEVERE CERVICAL CANAL STENOSIS
C3-4 WITH QUADRIPARESIS AND HYPALGESIA.
Anamnesis
The patient was operated by me
27-July-2010 for severe cervical canal
stenosis C4-5, C5-6, C6-7 with huge extrusion
C5-6. Then the patient was operated by me
23-October-2011
for LCS L3-4 and L4-5. The patient came
09-July-2023 complaining of neck and left upper
limb pain and right knee effusion and
investigations did not reveal after
investigations any serious problem and was
treated conservatively. She then came
20-August-2025 walking with help of 2 persons
complaining of tetraparesis and hypalgesia below
C2 with numbness of four limbs for the last 6
months. She was operated 40 days ago elsewhere for right
CTS without improvement.
On examination, The patient has mild neck pain
when looking up and down with Lhermitte's sign.
The power of the SCMMs and trapezius muscles are
normal. All the muscles including the deltoids
and below are weak (4/5)-(-4/5) weak below both
sides with hypalgesia from the forearms down
below with more dense sensation loss of
the right leg below the knee.
MRI of the cervical spine was performed the same
day showing severe cervical canal stenosis C3-4
with compression of the spinal cord and malacia
of the spinal cord at this level. Dynamic
studies ruled out overmobility the the
previously fused C4-5,5-6 and C6-7 in place. The
elements of compression were more from behind at
C3-4. Lab investigation and CXR were normal.
Midline incision in the back
of the neck with exposure of C2-3-4. Step-wise
drilling at the groove of the lateral masses, so
as to make the bony parts transparent, so as to
elevate of the C3 and C4 laminae in one piece,
avoiding during that any compression to the
dura. Smooth post-operative recovery. She was sent to the
ward.
FOLLOW UP
Too early now.
Comments
The patient have OPLL and the progression
is protected, that it took several years to escalate the
clinical manifestations to mandate surgery.
In this case the major compression was
from behind that posterior approach was mandatory.
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