Clinical case

myelopathy

In this specific clinical case, we are faced with a 58-year-old male patient who, after suffering a fall from 1.5 meters, arrives at the emergency room suffering from distal paresis of the upper extremities. A series of tests are performed upon arrival for a better diagnosis, the results of which are:

Preoperative

Left wrist x-ray: fracture of non-displaced radius distal extremity.
Electroneuromyogram: signs of injury to the posterior cord pathway to the 4 extremities, with greater involvement of the left lower limb and with injury level in the C7 cervical cord. Signs of chronic neurogenic lesion in territory corresponding to bilateral C5 and C6 myotomes of mild-moderate degree and moderate-severe degree in bilateral C7. Severe loss of motor units in the territory corresponding to the right C8-T1 myotome of central origin.
Cervical Magnetic Resonance: voluminous cervical disc herniations C4-C5, C5-C6 and C6-C7 with stenosis of the central spinal canal more pronounced at C5-C6 and cervical myelopathy C5-C6.

The patient progresses with distal paresis of the upper extremities with global muscle balance 4/5. The deep tendon reflexes are preserved and symmetrical, without sensory alterations and discrete amyotrophy of the intrinsic muscles of the right hand.

It is a spinal cord involvement (myelopathy) due to stenosis of the spinal canal in relation to the compression of the cord by cervical hernias.

Due to the neurological clinical involvement, surgical intervention of the cervical spine is required to decompress the spinal cord.

Regarding the fracture of the distal extremity of the radius, it was not displaced and orthopedic treatment was performed with an antebrachial cast with very good clinical and functional results.

Operation

We operate on the patient using a minimally invasive endoscopy technique without causing any damage to his tissues.

Under general anesthesia and in the supine position, a left anterior longitudinal approach was performed through the internal border of the sternocleidomastoid muscle.

Starting at the C6-C7 level, discectomy and resection of the posterior bone osteophytes and the posterior common vertebral ligament were completed. Both C6-C7 foramina were released bilaterally, and a Bryan prosthesis (Medtronic) was implanted. The technique was performed again at the C5-C6 and C4-C5 levels, releasing both foramina and the voluminous posterior osteophyte from the lower edge of C5.

Postoperative

The post-surgical evolution was satisfactory, and he was discharged from the hospital 48 hours later.

It has required evolutionary monitoring in relation to the involvement of spinal cord compression.

He progressively recovered strength and hypoesthesia in his extremities.

In the neurophysiological study carried out at 4 months, the exploration of the posterior cordonal tract was normal in both upper and lower limbs.