Recently (February 2012), a 77-year-old female patient was admitted to the hospital with tetraplegia (muscle strength of the extremities was only grade 1 to 2: only muscle fiber tremors and minor translation of the extremities were visible) after an accidental fall at home. The cervical spinal cord was gradually compressed due to the increasing size of the hard, tooth-like ossified posterior longitudinal ligament in the cervical spinal canal, and the elderly had already started to experience decreased limb strength, poor coordination, and difficulty in walking activities several years ago. As a matter of fact, the old man should have been operated long ago, but due to the fear of the old man and his family about the so-called risks of surgery, they have not been able to take surgical treatment, resulting in the symptoms getting worse and worse. There is no doubt that surgery is the best and only possible effective treatment for such a lesion, as only by removing the ossified material from the spinal cord can the spinal cord function be restored. However, the common enemy we, the patient and the family face – the risk of surgical treatment is very great: 1. The patient’s cervical ossified posterior longitudinal ligament segments are very long, from the first cervical vertebra to the seventh cervical vertebra, in which the ossified posterior longitudinal ligament from cervical 3 to cervical 6 segments form a serious compression on the spinal cord, and some segments of the ossified material on the spinal canal The encroachment rate of some segments on the spinal canal is as high as 90%, leaving the space for the spinal cord to survive is really “as thin as a cicada’s wing”. To rescue the spinal cord from such a state is as difficult and risky as rescuing someone from the ruins of a famous tofu-dreg project in an earthquake. 2. Diabetes” and other geriatric medical pathologies. And very obese, 1.5 meters tall, weighing up to 170 pounds. If the operation of the elderly must overcome several difficulties: 1, anesthesia off; 2, surgical trauma off; 3, complete loss of cervical spinal cord function off; 4, systemic failure of important organs off; 5, elderly surgery complications off, such as brain infarction, heart attack, heart failure, call failure, etc.. Of course, the most important thing is whether the elderly and their families can recognize these conditions and fully understand them. It is very fortunate that this is a family that can especially reflect the great spirit and traditional virtues of the Chinese nation. In the critical time when the family encountered real difficulties, they were united, courageous and brave, and defied all odds. Although we fully explained the risks of the surgery to the family, the family decided to operate with determination, hoping to give the old man a chance to recover his functions, which really touched us. There is no guarantee that the old man will be able to stand up again. We can only create a physical space for the recovery of spinal cord function through surgery, but we cannot accurately determine whether and to what extent the elderly can recover their limbs and bowel function. Really, at this time, our hearts were very helpless and sad, helpless for the limitations of medicine and sad for our limited ability! After determining the surgical plan, we had to carefully consider the surgical plan after having in-depth communication with the old man and his family and reaching an intention for surgical treatment. The spinal cord was compressed from the 3rd cervical vertebra to the 6th cervical vertebra, and the pressure on the spinal cord behind the 4th and 5th cervical vertebrae was particularly severe, with 80-90% of the spinal canal invaded by ossified material. The ideal solution is, of course, to remove the ossified material directly from the front of the spinal cord to relieve the spinal cord compression, but since the spinal cord compression in the elderly is too serious, the risk of removing the posterior longitudinal ligament directly from the front of the cervical spine is the highest, and the possibility of complete loss of spinal cord function is the greatest; moreover, the elderly belongs to the continuous posterior longitudinal ligament ossification, and it is quite difficult to complete the stability reconstruction of the cervical spine after removing the four cervical vertebrae from the front. It seems that the traditional classical posterior laminectomy decompression surgery is a good choice, as long as the laminae from the 3rd to the 6th cervical vertebrae are removed, the spinal cord can be indirectly decompressed because of the posterior space, but from my own experience with dozens of patients and reports in the domestic and foreign literature, if only such a surgical option is used, the hope of recovery for the elderly is relatively small, and because of this type of The elderly may experience intolerable postoperative neck, shoulder and arm pain due to the very high incidence of complications associated with this type of surgery; at the same time, the degree and effectiveness of decompression is limited due to the indirect decompression obtained in the spinal cord. Could a combination of the two surgical options be used to better avoid the risks? We finally decided to use a combined anterior and posterior approach for internal fixation of the cervical spine with decompression and fusion. The posterior cervical approach was performed by inserting pedicle screws and attaching them with titanium rods in five vertebrae from the second to the seventh cervical vertebrae, and then removing the posterior half of the vertebral plates of the third, fourth, fifth, and sixth vertebrae to give the spinal cord a space for posterior displacement, and then closing the incision. The patient is then placed in a flat position and entered from the front of the cervical spine, and all three vertebrae 4, 5, and 6 and their posterior longitudinal ligaments are removed, completely relieving the compression from the front of the spinal cord.