The patient was operated by me more than 20 years ago for PCD C4-5. The patient then came 26-October-2015 complaining of neck with cephalic pain with right shoulder pain for 4 weeks. MRI performed 20-October-2015 showing severe stenosis C4-5 with compression of the spinal cord. The patient is a known diabetic with arterial hypertension for 15 years. Using hearing device both sides.

On examination the patient has pain when turning the head to both sides more to right and looking up. There is weak extension both hands and both triceps 4/5.

The patient was sent for investigations and MRI of the brain performed 01-November-2015 showing slight dilatation of the ventricular system compatible with age with scattered periventricular lacunar infarctions. There is severe cervical canal stenosis C4-5, 5-6 with severe spinal cord compression and malacia of the spinal cord. Dynamic studies ruled out overmobility. The patient was sent for cardio consultation and advised to stop baby aspirin. 

Decompressive laminectomy C4.5.6 and partial of C3 was performed. The dura was transparent. Using MultiGen, bipolar motor stimulation of both dorsal branches of C4,5,6 roots lateral to the lateral masses was achieved with 2.7 and 2.5 V in the right  C5,6 root and 1.7 V in the right C4, 0.7 V to the left C4, 1.2, 1.3 to the left C5, 6 respectively. Using MultiGen, bipolar motor stimulation of both L5 roots was achieved with 1.2 V in the right root and 0.6 V in the left. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both L2 roots was achieved using 4 bended catheters 10 mm exposed length. During this ablation process the left L5 root had all the time motor response. Further motor stimulation done to the same roots and the response was 0.9 V in the right and 0.5 V in the left. to the right C5 and 6 respectively. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both C4,5,6 roots was achieved using 4 bended catheters 10 mm exposed length. Further motor stimulation done to the same roots and the response was 0.9 V in the right C4. 1.7 V in the right C5 and 1.5 V to the right C6 and 0.3 V to left C4, 0.9 V to left C5, 0.7 V to left C6. Routine closure of the wound.

Smooth postoperative recovery. The power of both upper limbs normalized. She was sent to the ward. There is no shoulder pain.

The patient claimed that in the next day that the left shoulder still in pain.

The patient  was operated previously by simple diskectomy without insertion of a cage or fixation. This could explain the later progression of stenosis in some cases. The patient has also stenosis of another level. This fact can explain that the previous surgery is not blamed to this situation.

The sooner the intervention, the better the outcome.

This is the first case using this technique during posterior decompression of the cervical spinal cord. The target was the dorsal branches of the roots. The next procedure will directed to the main root.

Here as in lumbar spine there is facilitation of the motor response after ablation.