The patient was operated by me 18-March-2015 for extruded disc C3-4 and C6-7 and postoperative check X-rays showed good alignment of the cages done 10 days after surgery upon the postoperative visit. The patient then came 02-April-2016 claiming that he got neck pain the last 6 months with intrascapular pain increasing upon effort. The last weak got left upper limb pain. CT-scan performed recently showing the left screws at the C3-4 level out of the bone 

On examination, the patient is in agonizing pain in the left side of the neck  without neurologic deficit. The patient was sent for more investigations and the MRI ruled out presence of other extrusions and the dynamic studies showed the left screws at C3-4 out of the bone.

Using the C-arm, the C3-4 level was identified. Using higher separate incision vertically over the C3-4 level, the construct was reached and exposed. The lower left screw is flail. All the construct was removed. The cage was fused with the C3 and C4 and check for instability or any micromotion was negative. Routine closure of the wound.

Smooth postoperative recovery. The patient was sent to the floor.

The patient in the previous surgery had difficulty in reaching the C3-4 level and the left screws could be near the border, but inside the bone,

During the surgery the lower left screw was flail and was the cause of pain generation despite the fact the segment was stable, but the muscles around are functioning and causing irritation.