21-MAY-2025  SAMIR SALEM DABABNEH  68 YEARS  TETRAPARESIS AFTER POSTERIOR CERVICAL DECOMPRESSION WITH SPONDYLOLISTHESIS C4-5 AND C5-6.

The patient came to the clinic 04-Januay-2025 telling that he deteriorated dramatically with subsequent tetraparesis after performed posterior cervical decompression of C3-4-5-6 elsewhere 14-November-2024.

On examination, the patient has shuffling gait. Can walk with difficulty, cannot be evaluated for Romberg stance. There is pain when turning the head downward, There is analgesia of the right hand. Hoffman positive more brisk in the left side and the deep tendon reflexes exaggerated in the left upper limb. There is weak grip right hand 4/5 and extension both hands 3/5 with both triceps muscle 2/5. SLRS was 10 degrees right side and 40 degrees left side without pain. There is weak right iliopsoas muscle, right quadriceps 3/5 and dorsiflexion right foot 4/5. Knee jerk exaggerated both sides, but Babinski and clonus negative both legs. Normal defecation and micturition.

The patient was sent for investigations  and MRI brain done 20-February-2025 showing scattered infarction both cerebral hemispheres and malacia of the spinal cord more at C5-6.  Dynamic studies showed spondylolisthesis C4-5 and C5-6 with the body of C5 pushed posterior. Medical treatment was started but the patient telling that is condition is deteriorating and asking for fixating his flail spine. The patient was asked to stop all anticoagulant elements and to be seen by cardiologist.

Using the C-arm, the level of C4-5-6 was identified and surgical exposure of C4-5-6 was achieved.  Using Nuvasive Helix cervical plate 38 mm and 4 variable angle screws 4.0x 15 mm o C4 and C6 and 2 screws fixed angle 4.0x 15 mm to C5, fusion of C4-5-6 was achieved.  Routine closure of the wound. The patient was sent to the ward. Clinically he was the same.

The patient shows improvement, but he has no accompanying relative and and when I visited his at 7.00 p.m. the patient was in the ground and a lot of blood due to disconnected cannula, for what I called the medical personnel to wash him and the room and the bed. Hiss brother a 85 years age was told and I toled the medical staff to keep close eye upon him.

The next day morning when I visited him, no accompanying relatives and the patient is in the ground with huge bruise in the left frontal area and with left sided hemiplegia. Urgent CT-scan was done to rule out intracranial hematoma.

The patient then sent to the ICU to have more strict observation.

The patient has malacia of the spinal cord due to previous cervical spinal canal stenosis and deterioration took place after surgery. Dynamic studies were not performed before the first surgery. The flail C5 further took place after surgery, which led to more further deterioration. At least fixation of the segment can prevent this element of instability.

Usually the problem with many visitors, but it is the fist time in my life I did not realized that no accompanying relatives. In the future I must pay attention to this situation and take the appropriate measures to avoid such unexpected postoperative unlucky scenarios.