The patient came to the clinic 02-February-2010 complaining of neck and right upper limb pain for 1 year. The condition is progressing and she progressed numbness all fingers right hand.

MRI cervical spine performed 19-December-2009 showed PCD C5-6 central and C6-7 more to the right.

On examination: the patient has weak grip and extension right hand 4/5 with right triceps muscle 3/5. There is limitation and pain when looking to the right and down and swaying the head to the left.

The patient progressed further deterioration and was advised to repeat MRI of the cervical spine, which was done 14-April-2010 showing complete occlusion of the right C6-7 foramen.

Using image-intensifier, discectomy of both C5-6, C6-7 was performed with removal of the extrusion in the right C6-7 foramen. Prestige LP cervical system Medtronic was inserted to both levels 5X16 mm dimension for C5-6 and 6X16 mm for C6-7 disc space. Check image-intensifier was repeated at all stages of the surgery and implants insertion.

Routine closure of the wound.

Smooth postoperative recovery, with full recovery of the power of the right upper limb.

The patient was essentially operated for the extruded disc C6-7 with complete occlusion of the right foramen.

The extruded central disc C5-6 was causing stenosis to the spinal cord. Taking the advantage of surgical intervention in the same area this stenosis was resolved surgically to prevent future escalation of the stenosis .

The best option is to keep the maximum dynamico-physiological functions of the violated levels. This can be achieved nowadays by applying the cervical disc system such as Prestige LP Medtronic, even for 2 levels.

Applying these rules, the late postoperative stenosis or disc extrusion of the above and down levels will be lowered considerably, by minimizing the stress which will be transferred to these mentioned levels.

It was noticed, that during insertion of the lower device, the previously inserted device at C5-6 slipped for 2 mm, for what it was impacted another time. After that the lower device slipped for 1 mm and it was reimpacted accordingly. This fact draw our alertness about possible slipping of the constructs. So as, to minimize this possibility, it will be recommended to keep the patient in collar for at least 3 months and to avoid strenuous activities.

So as to have perfect midline alignment of the device special instrumentation must be added to know that the device will be in absolute precision in the midline, before proceeding with the other steps of the operation. Anatomical markers are not sufficient and image-intensifier can be misleading.

New Brands of this construct must be added with slight curvature in the AP plane so as to have more perfect alignment of the upper and lower bodies (notice that the upper system is stuck with bone at C6, but  it is for 1 mm protruding at the lower edge of C5.