The patient an Iraqi citizen came to the clinic 06-October-2004 complaining of neck pain with numbness both upper limbs for 11 months, gradually deteriorating to include the legs and inability to walk. MRI cervical spine performed 05-June-2004 showing huge disc C5-6 and less the C3-4 with severe compression of the spinal cord.

On examination, the patient having neck pain when turning the head to right. There is severe weak grip and extension right hand 2/5, left hand 3/5 and both triceps muscle 2/5. Weak left deltoid 4/5. There is hypalgesia of the entire right upper limb and left hand with right D2-down to D10 and below the left D10. All the muscles of the lower limbs are weak more the right lower limb 1-3/5. Hoffman positive right side. There slight scoliotic stance. SLRS was 30 degrees right side without pain due to weakness. All deep reflexes are exaggerated with Babinski positive both sides with clonus right side. The patient is limping due to weak both lower limbs, more right foot.

The patient was sent for investigations and MRI cervical spine done 09-August-2004 showing huge extruded disc C3-4 and C5-6.

Transnasal intubation. Using the C-arm, the level of C3-4 was identified and discectomy of C3-4 was performed and the extruded pieces were removed until the dura was seen at the bottom of the removed disc cavity. The same was done for C5-6. Routine closure of the wound. Smooth postoperative recovery. The power of the upper limbs dramatically improved.

The patient came to the clinic 19-October-2004 with clean wound and the motor power upper limbs normalized, except the right hand 3/5 with shrinkage of the hypalgesia below the left D10 with full power of both lower limbs, but still limping. He was advised to continue medications and physiotherapy to improve the power of both lower limbs.

The patient came 20-June-2005 with full power four limbs, but still having hypalgesia below left D10.

The recurrence rate in cervical disc surgery is zero. Another disc can cause de novo extrusion.

In case of myelopathic syndrome, the recovery of the upper limbs is rapid, but the lower limbs needs more time to recover, but this case showed deviation from the rule, but the sensory deficit still persisting below left D10.