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The patient came to the clinic 17-September-2006 complaining
of neck pain for 20 years. The last 7 months he progressed weakness
of both lower limbs, then weak both upper limbs. MRI performed
06-September-2006 (bad quality) showed severe stenosis of C4-5, C5-6
and C6-7 with assimilation of of L3 and 4. On examination: the
patient is using crutches for 12 weeks. There is pain with
limitation of neck movement for all directions with weak left
deltoid and both biceps brachii, grip and extension both hands and
triceps both upper limbs with weak quadriceps femoris right leg.
abduction left knee and dorsiflexion both feet and planterflexion
right foot. Hypalgesia entire lateral aspect of the right upper limb
down to the median division of the right hand and the left C5
territory. He had SLRS 40 degrees both sides due to weakness and
Babinski was positive bilaterally.
MRI of the cervical spine was requested and performed, which
showed assimilation of C2-3 with PCD C3-4 and huge PCD C4-5 and C5-6
with malacia of the spinal cord at the last 2 levels.
Discectomy of C3-4, C4-5 and C5-6 was performed and fusion of the
C3-6 was achieved. Routine closure and smooth postoperative
recovery.
Comments:
1. Despite the small PCD of C3-4 , it was decompressed and
included in the fusion to prevent future escalation of problems,
since the stress points will be increased several times at this
level, if this was not performed.
2. A lot of companies produce cervical miniplates, and this
Zefeer brand, despite its low profile, has several disadvantages,
among them, the inability to see the disc spaces properly. Anyhow,
there is no perfect device and every one has its pros and cons. |
