The patient came to the clinic 27-June-2012 complaining of difficult walking for 5 months with LBP and bilateral sciatica. MRI lumbar spine performed 06-June-2012 showing bulge L5-S1. The patient is walking with help of 2 persons. On examination the patient had full power of the upper limbs and Hoffmann sign left side. SLRS was 60 degrees in the left with pain with weak all muscles of the lower limbs 3/4 left leg and right foot and 4/5 of the right quadriceps muscle with hypalgesia of the left leg extending 20 cm above the left knee. The patient then sent for whole spine MRI, which was done 03-July-2012 showing bulge L3-4 with mild degree of L5-S1 spondylolisthesis. The old lower screw still slipped as before after the performed by me operation 13-April-2012  for huge extruded disc C5-6. The patient did not perform MRI of the cervical spine and when he came 26-July-2012 telling that his condition is dramatically deteriorating with heaviness of the left upper limb the last 4 days with swelling of both legs. The patent was resent to complete the investigations with cardio consultation. The patient came 29-August-2012 with MRI of the cervical spine done 22-August-2012 showing severe cervical canal stenosis of C3-4, C4-5 and C5-6 with malacia of the spinal cord. The patient was resent for MRI of the brain and cardio consultation. MRI of the brain done first time 09-September-2012 of bad quality and he was advised to repeat it. It was done 25-September-2012 showing atrophic changes compatible with age and scattered lacunar infarctions, more around the left lateral ventricle. Cardio consultation gave permission only 13-October-2012 to undergo surgery under G.A.

On examination: the patient in addition to more deterioration of previous condition got weak grip extension and left triceps muscle left upper limb -4/5. The patient was examined immediately before surgery and it was clear that he cannot walk for 5 months and has severe tetraparesis more pronounced in the left upper limb and drop right foot.

In supine position with the head slightly flexed and under traction with 6 Kg, the lamina of C2,3,4,5 and 6 were skeletonized until the groove of the lateral masses was seen. Using high speed drill the laminae were drilled until the most lateral part abutting the groove of the laminae were seen and transparent. The drilling was done to include the lower third of C2 and upper third of C6. All these structures were reflected off the position and to the left to avoid any iatrogenic trauma to the spinal cord and removed in one piece. The epidural fat was missing and the bridging veins between the ligamentum flavum and the dura were coagulated and sharply bisected.

Routine closure of the wound. Smooth postoperative recovery with normalization of the power of the both upper limbs and considerable improvement of the power of both lower limbs.

The patient has severe stenosis of the spinal cord starting from C2-3 down to C5-6. The patient is deteriorating and only surgical decompression was the only solution to halt the deterioration.

Using drilling and thinning of the lateral parts of the laminae, give guaranty to avoid mechanical trauma to the spinal cord during surgery.