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02-SEPTEMBER-2003 WAFIQ UTHMAN JABER 54 YEARS HUGE PCD C5-6 WITH RIGHT BROWN-SEQUARD
SYNDROME.
Anamnesis
The patient came to the clinic 24-January-2003
complaining of neck pain for 3 years, cephalic
pain and left shoulder pain for 1 month.
Numbness of both legs for 2 weeks progressing up
to involve the upper limbs the last weeks more
the left hand.
On examination: the patient using crutches for 2
days, limping with wide based legs gait. He has pain when
looking up and to both sides more to the left with weak grip
and extension both hands 3/5 and both triceps
3/5 right , -3/5 left and the left biceps 4/5.
Weak both quadriceps 4/5 and dorsi and
planterflexion both feet 3/5 more weak in the
left. There is hypalgesia ulnar side of the
right upper limb and para-aneasthesia below the
nipples. Hoffmann positive both sides and all
deep reflexes are exaggerated and Babinski
positive both sides. Clonus of the feet. SLRS
was 30 degrees both sides due to weakness.
The patient was immediately sent to perform MRI
of the brain with contrast and MRI of the
cervical spine, which was done after 3-4 hours
to show a very huge extruded disc C5-6 with
malacia of the spinal cord.
Discectomy of C5-6
was done until the dura was seen along all the
posterior aspects. Samarys cervical cage 17x13x5
mm was inserted to C4-5 space and 17x13x6 mm to
C5-6 level. Trestle 1 level cervical plate 30 mm
length was used with 4 variable 4x14 mm
screws inserted to C4 and C5 bodies and 3 fixed
4x14 mm to C5 body. All stages of surgery were
done under C-arm control.
Routine closure of the wound.
Smooth postoperative recovery. The power of the
upper limbs became normal and the shooting
pain to the left shoulder dramatically
decreased.
FOLLOW UP
The patient
came to the clinic 14-September-2003 with clean wound
and the power of the right upper limb improved.
Sensory deficit still the same.
The patient
then came 20-December-2005 complaining of numbness
with mass reflexes both lower limbs. The upper limbs
sensation and power became normal, and the power of
proximal muscles lower limbs 5/5. There is
hypalgesia both feet below the ankle with weak dorsi
and planterflexion both feet 4/5. The patient sent
for MRI lumbar spine, which performed
24-December-2005 showing lumbar canal stenosis L3-4,
4-5 and L5-S1.
Comments
The patient has extrusion
of C5-6 causing the tetraparesis.
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
escaped from the plan .
