The patient came to clinic 24-September-2014 complaining of neck pain for 2 years with left upper limb pain. LBP with left lower limb pain. He is recently diagnosed with diabetes mellitus and has severe decreased hearing right ear for 25 years 10% and the left ear 50% for 8 years. He has prostate hypertrophy in Xatral 10 mg not in regular treatment. MRI lumbar spine done 23-September-2014 showing dehydrated disc L4-5. Dorsal MRI normal, but MRI cervical spine showing severe malacia of the spinal cord with extruded disc C5-6. Even the malacia is so severe and located at the disc level, but suspicion about MS aroused. The patient deny any trauma.

On examination; the patient using crutches for 2 years, has shuffling gait. There is no neck pain. There is weak grip and extension both hands 3/5. Triceps both arms 3/5. There is hypalgesia below the left D11 and right L3 levels. The deep reflexes both upper limbs are brisk with Hoffmann positive both sides. SLRS was 30 degrees right side due to weakness and 60 degrees left side due to weakness. There is weak all muscles both lower limbs -4/5, more the right leg.

The patient was sent for MRI of the brain with dynamic studies of the cervical spine. There are no data supporting multiple sclerosis.

Discectomy C5-6 with removal of the all extrusion until the dura was seen behind. Samarys cervical cage 6x15x12 mm inserted. Using Trestle cervical plate one level 16 mm with four fixed 4x16 mm screws, fusion of C5-6 achieved. Routine closure of the wound.

Smooth postoperative recovery. The power of all four limbs became normal.

The patient has radiculo-myelopathic syndrome, which functionally resolved after decompression.