The patient came to the clinic 01-March-2014 complaining of ataxia for 7 months with difficult walking, setting and standing. Neck pain for 1 year, numbness both hands for 30 years, which increased the last year. The patient is deteriorating with incontinent for urine the last 2 days and loss of defecation control. The patient is a known hypertensive and diabetic for 20 years. He underwent bilateral carpal tunnel release 30 years ago and CABG 7 years ago. He had CVA 4 years ago with right hemiparesis, which resolved within weeks. Lap Sleeve 3 years ago. He is allergic to Voltaren group. MRI cervical spine done 25-September-2013 showing severe cervical canal stenosis C3-4, C4-5 and C5-6 with malacia of the spinal cord.

On examination; the patient using crutches the last 4 months. Romberg immediately falling to the right. There is severe hypotrophy both interossii muscles both hands. Weal grip both hands 4/5, extension both hands 3/5, both triceps 3/5. Hypalgesia median distribution right hand. Hoffmann positive both sides. Exaggerated deep reflexes more the left side. The patient manifesting signs of astasia-abasia. SLRS was 30 degrees in the right and zero in the left due to severe weakness. Weak dorsiflexion both feet 3/5, weak quadriceps 4/5. Hypalgesia below the knees.

MRI of the brain done the same day showing small lacunar infarction of the left IC. There are no signs of NPH. The MRA of the brain and carotids were normal. The cervical spine showing severe stenosis at C3-4, C4-5 and C5-6 with malacia of the spinal cord with OPLL.

Decompressive laminectomy C3,4,5 and C6 was done. There is no epidural fat in the area. Meticulous hemostasis. Routine closure of the wound.

Smooth postoperative recovery. The power of four limbs improved dramatically.

The patient  has progressive deterioration due to CCS. Surgical decompression is the only solution to hold the deleterious effect of spinal cord compression.