The patient a Sudani citizen came to the clinic 02-March-2002 complaining of numbness both hands for 12 months with shuffling the right lower limb. Weak four limbs increasing. He is a known diabetic and using cardura for 5 years for prostate hypertrophy.

MRI of the cervical spine performed 27-February-2002 showing extruded disci C4-5, 5-6and C6-7 with severe spinal cord compression and gliosis of the spinal cord at these levels.

On examination: The patient is limping with shuffling gait dragging the right lower limb. He had minimal neck pain, but severe limitation of the neck movement to all directions. He had severe weak grip right hand, extensors both hands and both triceps muscles. Hypalgesia of C5 territories both sides. All pathologic reflexes brisk in four limbs with spastic tetraparesis. MRI lumbar spine performed, which was normal.

Though anterior approach discectomy of C4-5, 5-6 and C6-7 was performed and drilling the osteophytes and resection of the calcified OPLL was achieved. Using 52 mm length 3 level miniplate, bended to create normal lordosis and 8 screws  Scientx brand. Routine closure of the wound.

Smooth postoperative recovery. The power of four limbs improved. He was sent to the ward.

The patient the third postoperative day showed showed complete paralysis of the left deltoid and biceps brachii with difficult breathing. Chest X-ray and cervical X-ray were acceptable. High doses of Decadron made him to improve. The patient was discharged the 5th postoperative day and came back to the clinic 14-March-2002 with slight improvement of the weak left deltoid and biceps, but full power of all other muscles of four limbs. The hypalgesia disappeared.

The patient then came 25-June-2002 and 20-May-2003 with full power of all muscles, including the left deltoid and biceps muscles with hypalgesia index finger right hand and numbness both S1 territories.

The postoperative weakness of the left deltoid and biceps muscle, cannot be explained by surgical intervention, because it must be logically immediately after recovery of the patient from anesthesia. It happened 3 days after dramatic improvement. This could be explained by vascular accident or any systemic event , which we cold not catch at that time.