The patient came to the clinic 01-August-2015 complaining of difficult setting and standing for 2 years, shuffling gait for 35 years after suffering trauma to the spine with fracture of D10, with ataxia for 2 years and numbness right hand for 6 months.

On examination, the patient walking bended anterior with shuffling gait. Romberg position: sway to all directions with tremor both hands more the left. He has decreased hearing right side for 10 years after direct trauma to the ear. There is swan neck deformity  right hand. There is weak grip, extension right hand 4/5 and the right triceps 4/5. Weak right quadriceps 3/5, dorsiflexion right foot 3/5, left foot -3/5, planterflexion right foot 2/5 right foot 5/5. Senimet with pain killers were started.

The patient was sent for investigations and MRI of the brain showed rich iron deposition of both pallidi interna. There is slight stenosis of the cervical spine at C4-5 and 5-6. Dorsal showed the old wedge fracture of D10 with malacia of the spinal cord. MRI lumbar spine showed spondylolisthesis L4-5 with severe segmental stenosis.

Using the C-arm the level of L4-5 was identified. Decompressive laminectomy L4 and upper fourth of L5 was achieved. Foraminotomy both L5 roots was performed. Transpedicular fixation of L4-5 was done using legacy FA screws 3 6.5x45 mm to the L5 and right side of L4. The left side of L4 level was fixed with 7.5x45 mm screw because the first was polyaxial and it was lateral in position. It was removed and changed with more medial direction. Cross connector and the harvested bone was melted and used lateral to the rods 5 cm length bended to accept the natural curve of the area.  Routine closure of the wound.

Smooth postoperative recovery. The power of the left foot became normal and slight improvement of the power of the right foot.

The patient has many problems and recovery will depend upon the cause of his neurologic deficit.