The patient came to the clinic 22-September-2007 complaining of right shoulder pain for 2 years. 4 months ago got numbness and weakness right hand and the last 2 months noticed weak and numb both lower limbs. MRI lumbar spine done 06-May-2007 showing huge extrusion C5-6 more the left side with elements of mild stenosis at C4-5 and C6-7 levels.

On examination: the patient limping when walking with severe atrophy of the interossii of the left hand. Hoffmann positive both sides. There is weak grip both hands 4/5 and extension both hands: right 4/5 and left- 3/5 with severe weak triceps muscles both upper limbs -3/5. There weak dorsiflexion both feet and the quadriceps femoris: right 3/5 and left - 4/5. There is hypalgesia all volar surface right hand and ulnar side left hand.

MRI cervical spine done 29-September-2007 showing the same data as in the previous MRI.

Using Inomed Highline IOM, the operation was performed using TES-MEP protocol. Discectomy of C5-6 was performed and all the compressing elements were removed, including the bony elements.

Smooth postoperative recovery and improvement of the power of four limbs.
 

The patient has severe compression at C5-6 and mild stenosis above and below. It was decided to decompress the spinal cord at C5-6, leaving the other levels. If, in the remote future these findings became evident, then this will be corrected accordingly.

The disc extrusion had a protracted course, which predict relatively persistent pain in the long postoperative course.

Inomed Highline IOM TES-MEP mode was used in this case.