The patient came to the clinic 14-March-2011 complaining of neck pain and when bending the neck has numbness attacks both upper limbs, ulnar distribution and right lower limb for 3 years. The left lower limb numbness the last month.

MRI cervical spine performed 16-January-2011 showing extruded disc C5-6, C6-7 with severe spinal cord compression and malacia of the spinal cord.

On examination: the patient has shuffling gait with Lhermitte's sign when bending the head down. There is weak grip and extension both hands -4/5, and both triceps muscles more the left. The right lower limb is weak 4/5. There is no sensory deficit. All deep reflexes are exaggerated in the lower limbs and there is massive clonus both feet, more the right Babinski was positive in the right. The mass reflexes annoying the patient all the time.

MRI cervical repeated 16-March-2011 to confirm the plan of surgery.

Discectomy C5-6, C6-7 was performed until the dura was seen at all compressive points. Cervical cage standard  CFRP I/F  size 6x15x12 mm were inserted to the disc spaces with Vitos bone graft. Using DePuy (Jonson & Jonson)  Slim Loc plate  47 mm was used with one screw  14mm wide based in the most right upper and 5 slim lock screws 15 mm S.T. to achieve fusion C5-6-7.

Routine closure of the wound. Smooth postoperative recovery with improvement of the power of four limbs.

Lhermitte's sign is due to myelopathic changes of the spinal cord which is seen morphologically by the malacia of the spinal cord.

The immediate improvement of the power after surgery, can be explained by the disappearance of parabiosis of the spinal cord, which was triggered by the compressive elements.