The patient immediately start to show some recovery, but the atrophic condition of the muscles with rigidity, needs long time to recover partially. He was neglected and surgery must be done in the early stages, before irreversible changes took place.

The patient a Yemeni citizen came to Jordan with dense paraplegia and anesthesia below D1 for 12 months with gradual deterioration with incontinent for urine and defecation and atrophy of the muscles of both lower limbs, more pronounced in the right side. MRI done recently showing destruction of D1 with severe compression of the spinal cord with tumorous involvement of the body and right lateral mass and the right side of the lamina.

On examination: The patient is bedridden with Foley's catheter. Dense plegia-anesthesia below D1. Spastic pattern both lower limbs and atrophy of the muscles. Cannot control defecation.

Combined anterior and posterior approach was applied. Anterior approach was used to remove all the pathologic tumorous D1 vertebra and using large diameter Cloward instrumentation, an iliac graft was harvested and fixed to Scientx cervical plate and fusion of C7 and D2 was achieved. All stages of surgery were under C-arm guidance. The wound was closed and posterior approach was performed and all pathologic tumorous bone was removed and the right tumorous lateral mass was removed with preservation of the right running root. Using Luque rectangle, bended to accept the normal curve of the area with sublaminar wires, fixation of C6,7, and D2,3 was achieved. Practical radical removal of the tumor was achieved.  The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak.  Routine closure of the wound.

Smooth postoperative recovery. The power of the legs improved. He was sent to the ward.

The final histologic result was metastatic adenocarcinoma of gastrointestinal origin. The patient was in Yemen and by telephone communications and fax was advised to be seen by oncologist, but they told me that there is no oncologist there.

As I understood from a fax 15-October-2002, that he is controlling his urination and defecation and walking with help and they told me that they want to go to Umra at Saudia, and I advised them to be seen there by oncologist.