The patient came to the clinic 13-September-2012 complaining of inability to walk the last 45 days due to weak four limbs. The condition is deteriorating the last 15 days. The patient underwent cath one year ago and 2 tents were applied. She is in Plavix, Baby aspiring and concor 5 mg.

MRI cervical spine done 05-September-2012 showing severe cervical canal stenosis at C3-4, C4-5 and C5-6 with malacia of the spinal cord and mild spondylolisthesis of C4-5 and C5-6. The major compressing elements are from behind the spinal cord.

On examination, the patient has decreased vision right eye for 10 years. There pain when looking to the right up and down and bending the head to both shoulders. The patient in wheelchair and the power of the right upper and lower limbs ranking between 3 and 2/5. The power of the left upper and lower limbs are with in the range of 4-3/5. There is hypalgesia of the right side of the face and neck and right shoulder both upper limbs below the shoulders. There is hypalgesia of the left lower limb above the knee level. SLRS was 3-5 degrees in the right due to weakness. She is unable to make grip of the right hand.

The patient was sent for cardio consultation and MRI of the brain revealed atrophic changes compatible with age.

Decompressive laminectomy of C3,4,5,6 and partial of C2. There was no epidural fat at all segments. There is slight overmobility of the lateral masses and the lateral masses at C4-5 ligamentous structures were missing.

Routine closure of the wound. Dramatic improvement of the upper limbs.

The patient has severe compression from behind with malacia of the spinal cord. Considering her considerable deterioration, surgical decompression was indicating even with this age.

Fixating the over mobile segments was ignored because of age and osteoporotic bone.