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.
