Compressive Cervical Myelopathy

This is about one of my friends - a 46 year old married lady having progressive weakness in both Upper and Lower limbs since Jan 2009. No sensory symptoms, no history of bladder/bowel involvement.

Amination Findings:
E4 V5 M6    CNS-WNL

Motor Exam:
Bulk: Normal ALL 4 Limbs

Tone: Mildly increased in ALL 4 Limbs

Power:
Right Upper Limb: 4/5 All muscle groups, Grip 100%
Left Upper Limb: 3/5 All muscle groups, Grip 50%

Right Lower Limb: 2/5 - AT HJ/KJ;0/5 - AJ(DF);2/5 - AJ(PF);0/5 - EHL
Left Lower Limb: 1/5 - HJ;2/5 - KJ;0/5 - AJ(DF);0/5 - AJ(PF);0/5 - EHL

DTRS: 3+ ALL Joints

No Sensory Loss.

Congenitally fused CS-C3. Significant Spondylotic changes (+) Diffuse Disc bulge at C4-C5, C5-C6, C6-C7

Operative Procedure adopted:
C4-C6 Laminoplasty
Under GA (Open Door)

Present Condition:
Both lower limbs have significant weakness. Can not walk independently without support of a walker.

Advice Required:
1. What is the prognosis for the lady? Is there any other operative procedure required?

2. Who/Where can she find the best available treatment/management? She is willing to travel to any country in the world for treatment/management.

Thanks

[Nassim Abi Chahine, MD]

She will not get improvement without the adequate surgery. It was the very bad choice for treatment, simply the worst choice and probably by unexperienced hand. she needs a neck fixation in a cervical collar rigid type sterno-mandibular (Philadelphia type), then do an anterior approach liberation (Cloward's procedure or cage insertions) as soon as possible.