The patient was operated by me 05-July-2012 for lumbar spine problems and was doing well. The patient then came 31-October-2015 from Yemen, claiming that the last 50 days got neck pain with left upper limb weakness. The pain shooting to both lower limbs when looking up. He is in wheelchair the last 20 days with inability to walk.

On examination: the patient was examined in the wheelchair. The weakness of the right upper limb was ranging from 3 to 2/5 including the right deltoid muscle. The left deltoid was 0/5 and the other muscles left upper limb were ranging from -2 to 2/5 with analgesia of the lateral aspect of the arm, forearm and median distribution. Dorsiflexion both feet was 2/5 and planterflexion 0/5. The other muscles of the lower limbs including the quadriceps were 3/5. Hoffmann was positive and brisk left side with exaggerated reflexes left side. Babinski was positive both sides. He is using diapers with loss of micturition control for 20 days.

MRI of the brain and cervical spine performed the same day showing very huge extruded disc C3-4 with severe compression of the spinal cord.

Discectomy C3-4 was performed with removal of the extrusion until the dura was seen entirely at the depth of the disc space. Insertion of cornerstone anatomical cage 5 mm filled with bone graft. Fusion of C3-4 using Atlantis plate 21 mm length and 4 screws 4x15 mm. Routine closure of the wound. All stages of surgery were performed with C-arm control.

Smooth postoperative recovery. The power of the upper limbs dramatically improved, except the left deltoid muscle and the power of the lower limbs slightly improved.

The patient has severe functional impairment of the spinal cord. Time will tell the degree of postoperative recovery.