The patient came 21-January-2012 complaining of neck and LBP for 7 years with right upper and left lower limbs pain. MRI cervical spine performed 07-July-2008 showing huge extruded disc C5-6, C6-7 with malacia of the spinal cord. MRI lumbar spine performed 14-December-2010 showing PLD L4-5 with segmental stenosis. MRI cervical spine repeated 06-January-2011 showing huge extruded disc C5-6, C6-7 with malacia of the spinal cord.

On examination, the patient is walking bended, limping and cannot walk more than 10 meters. There is pain when turning the head to all direction, more to the right and upward. There is weak grip right hand 4/5, extension the hand 3/5 and the right triceps power is 4/5. SLRS was 70 degrees with pain both sides. There is weak dorsiflexion right foot -4/5 and left foot 4/5.

MRI of the cervical and lumbar were repeated 22-January-2012 which confirmed the presence of huge extrusion of C5-6 and C6-7 more to the right with malacia of the spinal cord. There is also stenosis at L4-5 with bulge L5-S1 disc. The patient was advised to undergo surgery for cervical problem first.

Using C-arm, discectomy of C5-6, and C6-7 was performed with osteophytectomy. The extruded disc C5-6 was adherent to the dura in the right side. Circumferential release was done and the hard layer was thinned up to 0.01 mm thickness leaving a shell with the dura so as not to violate the integrity of the dura or cause spinal cord injury. Fidji cervical plate  with NovaBone 12x15x6.1 mm inserted to the C5-6 level and 12x15x5.3 mm to the C6-7 level. Using Trinica Zimmer 36 mm 2 level plate, fusion of C5-6-7 was achieved with 2 variable screws inserted to C5 and 2 screws 16x4.2 mm  to C7. Fixed 2 screws 16x4.2 mm were used to fix the C5 body. Stepwise control with the C-arm.

Routine closure of the wounds. Smooth postoperative recovery with improvement of the power of the right upper limb and both feet.

The patient have problems in the cervical and lumbar spine and both mostly needs surgical intervention. The priority is given to the compressed spinal cord at the cervical level.

The patient got improvement of the all involved muscles, even the feet, confirming that the weakness of the feet was partially due to spinal cord involvement.