The patient came to the clinic 24-December-2012 complaining of neck and both upper limbs pain for 5 months  with exacerbation of the left upper limb pain the last month with numbness of the thumb left hand with numbness of the left side of the body below the umbilical region. The patient cannot sleep due to pain. The patient underwent surgery for PLD L4-5 2 years ago and cervical discectomy C5-6 and C6-7 with cage insertion 3 years ago. The patient is a known hypertensive for 10 years.

MRI cervical spine done 01-November-2012 showing extruded disc C4-5 with severe compression at C4-5 and malacia of the spinal cord and inverted curve of the cervical column from C4-7 segments.

On examination: The patient have weak grip right hand 4/5, extension right hand 3/5, left hand 4/5 and the right triceps muscle 4/5. There is hypalgesia of the median distribution right hand. There is hypalgesia below the left nipple with weak right leg 4/5 all muscles. Hoffmann positive in the right with Babinski also in the right with bilateral clonus more brisk in the right side.

The patient was sent to perform MRI of the brain with contrast, which was done 24-January-2013 partial study without contrast showing scattered lacunar infarctions of no clinical significance.

Half of the old wound was used to perform discectomy C4-5 with total cleaning until the dura was seen behind the bodies of C4 and C5. Samarys cervical cage 17x13x5 mm was inserted to C4-5 disc space. Inspection of the old C5-6 was stable, but the one at C6-7 was flail. Considering that the inverted curvature of the spine fusion of C4-5-6-7 was done using Trestle cervical plate 45 mm length with 4 fixed screws  16 mm length to C5 and C6 and variable to C4 and C7  same length. The tightening was done to maximize the reduction of the inverted curve to accept the curve of the plate. All stages of surgery were done using C-arm.

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

The patient has extruded disc C4-5 with spinal cord compression and inverted curve of the spinal column. Both must be corrected to obtain the at most better outcome.