The patient came to the clinic 15-March-2010 complaining of neck pain for 1 year and pain of both upper limbs and shoulders with cephalic syndrome. She is unable to walk for several months.

On examination: the patient is unable to elevate both upper limbs with limitation of neck movement and pain when looking to right and downward. She has analgesia both upper limbs from C3 down to D2 both sides. There is profound weakness all muscles upper limbs 3/5. Hoffmann positive in the left side and Babinski positive both sides. There is hypalgesia both lower limbs below the knees.

She is a known hypertensive for 5 years.

MRI brain with contrast and MRA of the brain and carotids and MRI cervical spine done 16-March-2010 showing severe cervical stenosis at C3-4 with malacia of the spinal cord at this level. ESR was 64 mm/h and uric acid was 6.8.

Decompressive laminectomy of C3-4 and partial of C2 and C5 was performed. There was no epidural fat in this area and the compression was more pronounced in the right side.

Routine closure of the wound.

Smooth postoperative recovery, and the power of both upper limbs became better.

Cervical canal stenosis is a progressive disease and the sooner the compression is removed the better the outcome.

When the major compressive elements are located posteriorly, posterior decompression is the preferred approach.