History
The patient is a 54-year-old left-hand dominant male. He is a plumber and presented to Dr. Stieber with complaints of left arm weakness and numbness. The patient reported difficulty walking with balance problems and a loss of manual dexterity (eg, difficulty writing).
Examination
On physical examination, he was found to have an unsteady gait, hyper-brisk reflexes (reflexes are increased), as well as significant left arm weakness and numbness.
Pre-treatment images
Figures 1 and 2 are side (lateral) x-rays of the cervical spine in extension, neutral, and flexion.
Figure 1. Extension
Figure 2. Neutral
The patient’s MRI findings revealed multi-level cervical spinal stenosis with pinching (compression) of the spinal cord (Figure 4).
Figure 4. MRI; arrow points to a level of spinal cord compression
Figures 5A-5D are axial or overhead views of specific levels of the spine.
Figure 5A. C3-C4
Figure 5B. C4-C5
Figure 5C. C6-C7
Figure 5D. C6-C7
Diagnosis
Cervical spondylotic myelopathy; compression of the spinal cord at multiple levels resulting in spinal cord dysfunction
Selected Treatment
The patient was treated with a C3-C7 cervical laminoplasty. The roof of the spinal canal was split and hinged open at each level (eg, C3-C4, C5-C6, C6-C7). The patient’s own bone was affixed to create an expanded arch, increasing space for the spinal cord and nerves while maintaining motion.
Post-operatively, the patient was placed in a soft cervical collar for two weeks.
Figure 6. Post-operative anteroposterior (front to back, AP) x-ray
Figures 7 and 8 demonstrate that surgery maintained cervical (neck) motion.
Figure 7. Extension
Figure 8. Flexion
Figure 9. Neutral
Figure 10. Extension
Outcome
The patient experienced near complete resolution of his symptoms two weeks following the procedure. Strength in his left arm was completely restored. Walking and writing substantially improved. At one-year after surgery, the patient’s cervical range of motion was maintained. He returned to his demanding work as a plumber.