AN 80-YEAR-OLD woman presented with a left C7 radiculopathy. Cervical magnetic resonance imaging showed spinal stenosis at the C7 through T1 vertebrae, with anterolisthesis. The patient underwent posterior C7 decompression laminectomy, C7-T1 foraminotomy, and spine stabilization with posterior fusion of the C7 through T1 vertebrae with pedicle screws and local autogenous bone graft. The patient awoke with marked bilateral upper extremity weakness, worse on the left side, with anesthesia in the bilateral medial forearms and digits 4 and 5. Biceps and triceps reflexes were absent bilaterally, but other reflexes were normal in the lower extremities. Plantar responses were extensors.