The patient came to the clinic 31-December-2013 complaining of inability to move the four limbs and loss of micturition control for 7 months of sudden onset. He has tinnitus of the left ear for three months. He has diabetic retinopathy for 18 months. MRI lumbar spine done 30-March-2013 showing old wedge fracture of L2 of no clinical significance. Cervical MRI showed extruded disc C4-5 more to the right with severe stenosis at C4-5, C5-6 levels. CT-scan of the brain done 04-September-2013 showed old infarction of the right cerebellar hemisphere. The patient is a known diabetic for 20 years insulin dependent. He is hypertensive for the same period, underwent KABAG 8 years ago.

On examination; the patient walking with help of person and with crutches. He has hypotrophy of both interossii muscles both hands. The grip of both hands 4/5, extension left hand 3/5, right 4/5. Triceps both upper limbs -3/5. There is paraaneasthesia below C3 level. Quadriceps both lower limbs 3/5, dorsi and planterflexion both feet 3/5 and the other muscles of the lower limbs 4/5. SLRS was 45 degrees without pain due to weakness. There are no pathologic reflexes with almost areflexia.

The patient sent for new MRI of the brain, cervical and dynamic X-ray of the cervical spine and done 20-January-2014 showing the small lacunar infarction of the right cerebellar hemisphere. MRI cervical spine showed severe cervical canal stenosis at C4-5, C5-6 levels with more compression from the posterior elements with malacia of the spinal cord. X-ray of the cervical showed ossification at C5-6 level.

Decompressive laminectomy of C4,5,6 and upper 1/3 of C7 with preservation of the spinous process of C7. There was no epidural fat. Routine closure of the wound.

Smooth postoperative recovery. The patient showed dramatic improvement of the power of four limbs.

The patient has progressive cervical canal stenosis. The sooner the surgical intervention, the better the postoperative outcome.