The patient was operated by me 01-May-2008  for PLD L4-5 with segmental stenosis, after what she improved, but she came then 03-October-2010 complaining of LBP with left sciatica. MRI lumbar spine was performed 09-October-2010 showing a ganglion at L4-5 left facet. The patient was advised to keep in conservative treatment. The patient was doing well until she felt down in October-2011 after what she got difficult walking with ataxic gait with exacerbation of left sciatica. The patient came to the clinic 19-November-2011.

On examination, the patient is limping with exaggerated scoliotic stance. There is weak grip and extension of the left hand 4/5 with left triceps muscle 3/5. Hoffmann was positive in both sides with DTR more brisk in the left side. The left quadriceps femoris was -4/5 with SLRS 45 degrees in the right without pain, but 50 degrees with pain in the left. There was clonus in the left foot.

The patient was sent for MRI of the cervical and lumbar spine, which were done 26-December-2011 showing severe cervical canal stenosis C3-4 with malacia of the spinal cord at this level. The L4-5 ganglion still the same size.

Decompressive laminectomy of C3-4 and C5. There was no epidural fat at these levels. The laminectomy was extended to abut the lateral masses, without violating them.

Routine closure of the wounds. Smooth postoperative recovery with improvement of the power of the involved weak muscles.

The patient had ganglion of the left L4-5 facet compressing the L5 root, but she was in good condition before the trauma in October-2011, for what its role was omitted. The cause of ataxia and left sided weakness with pathologic reflexes was the severe spinal cord compression with subsequent myelopathic syndrome.

In case of negligence and performing the surgery at the lumbar area, the patient with such cervical spine involvement could result in postoperative quadriplegia.

Special attention was paid to the neck during rotation of the patient to the prone position.