The patient  a Yemeni citizen came to the clinic 03-May-2012 in wheelchair and inability to walk for 2 months . His condition started after lifting athletic crossbar 7 months ago, after what he got severe numbness of both upper limbs. The patient then got intrascapular pain after 4 months with heaviness of the right lower limb. He is using wheelchair for 2 months.

MRI of the whole spine was performed 03-May-2012 showing very huge extruded disc C6-7 compressing the spinal cord with malacia of the spinal cord.

On examination, the patient in wheelchair, can walk with assistant of 2 persons. The biceps brachii are 5/5 but the grip of both hands are 3/5, unable to extend the right hand and extension of the left hand and both triceps muscles are weak 3/5.  SLRS was 5 degrees both sides due to weakness and there is exaggerated reflexes both lower limbs with massive clonus. Babinski was positive both sides. Weak proximal muscles both lower limbs 4/5 and distal muscles 3/5. There is sensory deficit, nor micturition or defecation problems.

Discectomy of C6-7 with total removal of the extruded disc inside the canal with upward migration. The dura was seen at the entire posterior aspect. Fidji 17x6.1x12 cage with NovaBone was inserted to the C6-7 space. Using Trinica cervical one level plate was used with four fixed 16 mm length to fuse C6 and C7.

Routine closure of the wound. Smooth postoperative recovery.  The power of the upper limbs normalized and the power of the lower limbs improved, but the clonus still having place.

The patient has profound quadriplegia-paresis, the sooner the intervention, the better the outcome.

The recovery process will depend upon various elements. The roots recover promptly, the motor fibers of the spinal cord recover at lower speed, but sensory deficits and fibers responsible for spasticity and clonus recover slowly and partially over months.