The patient a Libyan citizen, came to the clinic 09-October-2002 complaining of neck pain for 10 years with right upper and lower limb pain for 4 years. He was operated for PCD 22-September-1998 through posterior approach elsewhere. After relative improvement, 2 months after surgery got heavy legs with spasms and Lhermitte's sign when looking down.

On examination: The patient is limping, there is neck pain when looking for all directions and weak flexion and extension right hand and right triceps muscle. There is spastic paraparesis both lower limbs more pronounced in the right side. Rossolimo's sign positive right side and bilateral Babinski with clonus both feet.

The patient was sent for investigation and MRI lumbar spine showed extruded disc C4-5 right side and C5-6 right side with malacia of the spinal cord and residual after posterior compression.

Through anterior approach the level of C4-5 was identified and discectomy of C4-5 with osteophytectomy was achieved until the dura was seen at the bottom of the disc space. The same was done for C5-6 and C6-7. Using 4 level Scitex plate with screws, fusion of C4-5-6-7 was achieved. All stages were done under C-arm control. Routine closure of the wound.

Smooth postoperative recovery. He was sent to the ward.  He showed dramatic improvement of the three limbs, disappearance of Lhermitte's sign and the spasticity decreased.

The patient did not came to the clinic for follow up?

The aim of the surgery is to alleviate the pain, but the malacia of the spinal cord needs long time for partial recovery.