The patient came to the clinic 14-September-2014 complaining of four limbs pain with difficult walking with deterioration last year, that he is using crutches the last 2 months. He is a known hypertensive for 10 years and underwent surgery 2009 and 2010 in the lumbar area elsewhere. MRI lumbar spine done 30-September-2013 showing laminectomy L4 and L5, but the data are bad quality. Cervical MRI performed the same day, better quality showing spondylolisthesis C7-D1 with malacia of the spinal cord with severe cervical canal stenosis C2-3, 3-4, 4-5, 56 and C6-7. MRI of the cervical spine repeated 08-April-2014 showing the same data as before.

On examination; the patient is using crutches for walking with both deltoid, biceps, triceps and extension of both hands -3/5. The grip both hands 4/5. There is hypalgesia below C3 both sides. Weak dorsi and planterflexion both feet 4/5. The right quadriceps 4/5 and the left 3/5. SLRS was 20 degrees in the right and 20 degrees in the left due to weakness. All deep reflexes are exaggerated and Babinski positive both sides with brisk clonus more the left foot.

Anterior fusion of C7-D1 using Alphatec spine cervical plate one level 22 mm length and 4 monoaxial screws 16 mm length. The wound was closed. The patient then was repositioned and decompressive laminectomy of C3,4,5,6 and partial of C2 and C7 was achieved trying not to cause surgical trauma to the spinal cord. Routine closure of the wound.

Smooth postoperative recovery. The power of the four limbs dramatically improved after surgery.

The patient has a lot of problems which needed surgical correction. Anterior fusion of C7-D1 is more reliable than posterior, for what it was done in the first stage. Decompression was done after repositioning the patient.