MR. Sasane

May 7, 2022 By Dr. Sangram Rajale In Cervical Spondylosis, more than 60, Myelopathy, Laminectomy, Gait-Imbalance

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History :

  • The 65-year-old gentleman came with complaints of chronic neck pain, weakness in both hands, and frequent falls, along with a history of lost fine motor skills in the left upper limb, weakness in the left lower limb, tingling in the right upper limb, and disturbances in bowel/bladder function, faced significant disabilities that impacted various aspects of his daily life.
  • The neck pain made it challenging for him to perform activities requiring head movement or sustained neck positions.
  • The weakness in his hands affected his ability to grasp objects, perform fine motor tasks, or maintain a firm grip for stability.
  • Combined with instability and frequent falls, he struggled with mobility, leading to risk of injuries and reduced independence.
  • The loss of fine motor skills in the left upper limb further reduced his ability to perform tasks requiring dexterity and precision.
  • The tingling sensation in the right upper limb caused discomfort and affected his sensory perception in that area.
  • The bowel/bladder disturbances, such as urgency and constipation, added another layer of disability, impacting his comfort and requiring careful management to maintain continence and prevent complications. 
  • Overall, these disabilities significantly impacted his functional abilities, mobility, and quality of life, necessitating comprehensive evaluation and appropriate interventions.

MRI :

The MRI report findings were highly relevant to the symptoms and disabilities described earlier. Cervical spondylosis is noted as a condition where there was degeneration of the cervical spine, aligning with the patient’s chronic neck pain and related issues. The disc degeneration and hard disc herniation at multiple levels (C4-5, C5-6, and C6-C7) could explain the weakness in both hands, instability, and frequent falls, as these conditions could lead to nerve compression and spinal cord dysfunction. The presence of ossification of the posterior longitudinal ligament (OPLL) causing severe cord compression likely contributed to the patient’s symptoms of weakness, tingling, and bowel/bladder disturbances.

Cord myelomalacia, which softened the spinal cord, further suggested significant damage and correlated with the patient’s neurological deficits. The narrowing of lateral recesses and neural foramina, as well as compression of exiting nerve roots, were consistent with the observed symptoms of weakness and sensory abnormalities in the upper and lower limbs. The thickening of the ligamentum flavum at all levels could also contribute to spinal canal stenosis and nerve compression, exacerbating the patient’s disability. Overall, the MRI findings provided a clear anatomical basis for the patient’s clinical presentation and associated disabilities

Operation :

The patient underwent a surgery called C3-C6 laminectomy on May 7, 2022, under general anesthesia. This surgery involved the removal of parts of the lamina (the back part of the vertebrae) in the cervical spine (neck region) from the third to the sixth vertebra. It was done by Dr Sangram Rajale.

The reason for performing a laminectomy is typically to relieve pressure on the spinal cord or nerves. In this case, it was likely done to address issues such as spinal cord compression or nerve root compression, which could have been causing symptoms like weakness, pain, or tingling in the arms or hands. By removing part of the lamina, the surgeon aims to create more space within the spinal canal and alleviate the compression on the nerves, thereby improving the patient’s symptoms and function.

After Discharge :

Following findings were seen at 8-9months after surgery. The patient’s muscle power was significantly improved compared to the before surgery, with normal strength observed in all muscle groups. Sensation was intact. Additionally, clonus was absent, which is a positive sign indicating a lack of involuntary muscle contractions. Overall, the patient showed significant improvement in neurological function and muscle strength after the surgery and subsequent recovery period.

Muscle Power:

Right Grip Strength: Normal (5 out of 5) Right Finger Abduction Strength: Normal (5 out of 5) Right Shoulder Strength: Normal (5 out of 5) Right Biceps Strength: Normal (5 out of 5) Right Triceps Strength: Normal (5 out of 5) Right Wrist Strength: Normal (5 out of 5)

Sensory Examination:

Sensation is intact Clonus: Not observed (absent)