The patient came to the clinic 13-September-2015 with clinical history of dysphonia and delayed milestones since birth. He could walk at 12 years of age with inability to control both hands, but he could manage himself and could marry and has three sons. The last three years he deteriorated and he became in wheelchair with right severe plegia of the upper and lower limbs.

On examination: the patient has dysphonia in wheelchair with deep tetraparesis. He can understand the verbal commands and the memory function is intact. He has pain of the neck when turning the head up and to the right . There is hypalgesia below C3 more deep in the left side. The right deltoid is 0/5, the left is -3/5. The right biceps muscle is 1/5 and the left 2/5. The grip of the right hand 2/5 and the left 3/5. The extension of the right hand 0/5 and the left 1/5. The right triceps muscle is 0/5 and the left 4/5. There is flexor deformity of the right upper limb. The right quadriceps is 2/5 and the left 4/5. Dorsi and planterflexion right foot 2/5 and the left 3/5. All deep reflexes are exaggerated and more brisk in the left upper limb. All pathologic reflexes are present in the upper and lower limbs with clonus both feet.

MRI cervical spine performed 10-September-2015 showing severe cervical canal stenosis at C3-4 and C4-5 with severe malacia of the spinal cord at these levels.

 Decompressive laminectomy of C3,4,5 without violating the epidural space. Routine closure of the wound.

Smooth postoperative recovery. The patient still the same and was sent to the ward.

The patient patient has an old insult to the brain since childhood. The cervical stenosis was added to his condition.

The aim of the surgery is to stop his clinical deterioration.