The patient came to the clinic 13-November-2019 complaining of weak right upper limb with pain for 18 months. MRI cervical spine performed 15-October-2019 showing severe stenosis at C3-4 with malacia of the spinal cord. The patient underwent right CT-release without improvement. The patient is limping due to old left knee problem since 1990. The patient has asbestosis with elements of bronchial wheezes.

On examination: the patient has weak right deltoid muscle 3/5, right biceps 4/5, grip right hand 3/4, extension right hand 3/5 and triceps right upper limb -3/5. There is hypalgesia left upper limb starting from dermatome C4 down to C7 with pain when turning the head up. Hoffmann sign positive both sides more brisk right side and weak right quadriceps muscle 4/5.

The patient was sent for investigations and MRI of the cervical spine performed the same day showing wide based extruded disc C3-4 more to the right with stenosis at C3-4 and malacia of the spinal cord at C3-4, 4-5. Dynamic studies confirmed retrolisthesis C3-4, C4-5.

Discectomy of C3-4, C4-5 was achieved and the right side of C3-4 was followed to achieve removal of the extruded pieces with osteophytectomy. Nuvaisive Corent cervical cages 15x12x6 filled with bone graft were inserted to C3-4 disc space. Nuvaisive Corent cervical cages 15x12x5 filled with bone graft were inserted to C4-5 disc space. Nuvaisive helix R cervical plate 42 mm length and 6 plate screws 4x12 mm ( 2 fixed and four variable) were used.  All stages were guided with C-arm. Routine closure of the wound.

Smooth postoperative recovery. The power of the right upper limb normalized. He was sent to the ward.

The patient spinal cord malacia is the result of stenosis and overmobility of both level. Discectomy, osteophytectomy and fusion is the best treatment plan.