Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit  neurosurgery.tv

71 years old patient came with quadriparesis for 7 months, progressed over the time and inability to walk the last month. The left side was more affected.  The patient had assimilation of C3 and 4 with severe compression of the spinal cord at C2-3, C4-5 and C5-6 levels with malacia of the spinal cord at the mentioned levels.  The major compression was from behind due to ligamentum flavum hypertrophy and instability of the spine at C4-5 and C5-6 levels with the posterior elements of C3-4-5 consisting the major part of compression.
the patient was operated from behind. and fixation of the flail segments was achieved by fusion of the lateral masses by two method the C5-6 was performed by screws 12 mm length and C4-5 by bone stablers 8 mm length.

The following points need emphasis in this case:
1. Posterior decompression of the stenosed cervical canal takes more elements of postoperative deterioration, especially, if the steosing elements are located anteriorly. To avoid such situation, it is wise to evaluate the direction of the compressing element, if it is posterior, then nothing to be done by anterior approach. Laminectomy must be performed by drilling and thinning of the bony parts as this as transparent, to remove them by artery or any thin instrument to avoid possible surgical trauma caused by Smith-Kerrison rongeurs used in the routine practise.
2. In presence of instability, there are many ways to stabilize the lateral masses. Using miniscrews is a good option, but using bone stablers as done in this case is not advisable, since they slip in the next following hours after the operation.