The patient came to the clinic 07-December-2004 complaining of LBP with right sciatica for 4 years with exacerbation of right sciatica the last 40 days. The patient is a known diabetic for 9 years. On examination at that time he was limping with exaggerated scoliotic stance. Hoffmann sign was positive in the right with weak grip, extension right hand and right triceps muscle 4/5. SLRS was 45 degrees with pain in the right with weak all muscles right leg 4/5. All deep reflexes of the lower limbs were exaggerated with clonus both feet. The patient was sent for investigations, including brain, lumbar and cervical MRI, but he escaped.

The patient then came 22-January-2007. He is complaining of agonizing right sciatica. MRI lumbar spine done 21-December-2007 showed extruded disc L4-5 with right downward migration. The patient was operated for the extruded disc L4-5 24-January-2007.

The patient then came 30-December-2009 complaining of right sciatica with numbness both hands and tendency to fall during walk. There is hypotrophy of the interossii both hands with weak extension of the right hand 3/5 and right triceps muscle -3/5. weak all muscles right lower limb 4/5. Investigations were requested and done 21-April-2010: MRI brain showing scattered infarctions, more the right parietal lobe. Cervical canal stenosis at C5-6 and C6-7 with malacia of the spinal cord at these level. The patient was advised to undergo surgery for the cervical stenosis, but he escaped.

The patient then came 15-January-2011 telling that he underwent to stent procedures and discectomy of C5-6, C6-7 at KHMC 2 months ago with further deterioration of his condition. The weak now both upper limbs as follow: right hand extension 3/5, left 4/5, right triceps muscle 2/5 and left 3/5. The patient was advised to undergo posterior decompression, but another time escaped.

The patient then came 03-November-2013, telling that his condition is deteriorating the last 6 months with numbness of the left upper limb with numbness of the four limbs the lat week. MRI cervical spine showing stenosis of C5-6, C6-7. Lumbar MRI showed mild spondylolisthesis L4-5.

On examination is limping with shuffling gait. He has severe atrophy of both interossii with inability to extend both hands with clawing deformity. The grip of both hands now 4/5 with the same weakness of other muscles of upper limbs as last time. Dorsiflexion right foot 3/5 and left 4/5. Planterflexion right foot -4/5. There is hypalgesia ulnar distribution both upper limbs and the chest cages down to the Th 7. Hypalgesia all right lower limb below D12 and the left foot.

MRI cervical spine done 04-Novemebr-2013 showing cervical canal stenosis C5-6 and C6-7 with malacia of the spinal cord at these level.

Skeletonization of C4,5,6 and C7. The spinous processii were identified using the C-arm. Using high speed drill, the laminae of C4,5,6 and upper half of C7  were thinned and removed to avoid any surgical trauma to the spinal cord. All the compressive elements were eliminated. Routine closure of the wound.

Smooth postoperative recovery. The power of four limbs became better, that the power of the feet became normal.

The patient had cervical canal stenosis. Discectomy will not resolve the stenosis even if putting the cages to expand the spaces.

Simple decompressive laminectomy is the best solution in this case.