The patient  came to the clinic 08-April-2012 complaining of LBP for 10 years with numbness both legs more the right. He cannot stand for more than 5 minutes. He noticed deterioration the last 2 years with escalation of the right sciatica. MRI lumbar spine performed 07-April-2012 showing severe lumbar canal stenosis L2-3, L3-4 and L4-5. He was complaining also of numbness both ulnar distribution for 4 years.

On examination, the patient walking bended  with slight neck pain when looking down with weak grip both hands 4/5 and triceps both arms -4/5. There is weak dorsiflexion both feet 4/5. SLRS was 85 degrees with tightness both sides.

The patient was sent for MRI of the cervical spine, which was done 09-April-2012 showing very huge extruded disc C5-6 with bulge C4-5 and C6-7 with malacia of the spinal cord at the extrusion site.

Discectomy with osteophytectomy C5-6 until the dura seen all over. Discectomy C6-7 with removal of centrally located extrusion. Insertion of Fidji cervical cage 12x17x6.9 mm to the C5-6 level and 12x17x6.1 mm to the C6-7 level with NovaBone. Trinica 42 mm length cervical plate with 2 variable 16x4.2 mm screws to C5 and four fixed 16x4.2 mm to C6 and C7 were used to fuse C5-6-7. All stages of surgery were performed with image-intensifier.

Routine closure of the wound. Smooth postoperative recovery and the power of  both upper limbs became normal.

The patient has lumbar canal stenosis and very huge disc C5-6 compressing the spinal cord with malacia of the cord. This take precedence over the problem of the lumbar spine.