The patient a Libyan citizen came to the clinic 04-October-2004 complaining of neck pain after RTA 1988. Left shoulder pain for 3 years with numbness ulnar distribution both hands for 1 year. MRI cervical spine done 06-July-2004 showing huge disci C5-6, C6-7 with malacia of the spinal cord at these levels.

On examination, the patient having neck pain when turning the head to left and down. There is severe weak grip and extension left hand 3/5 and both triceps muscle 3/5. There is hypalgesia of the medial aspect of the left upper limb and hand. Hoffman positive both sides. There slight scoliotic stance. SLRS was 70 degrees both sides without pain. All deep reflexes are exaggerated with Babinski positive both sides with clonus. The patient is limping due to weak both lower limbs, more right foot.

The patient was sent for investigations and MRI cervical spine done 10-August-2004 showing huge extruded disc C5-6 and bulge C6-7.

Using the C-arm, the level of C5-6 was identified and discectomy of C5-6 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 C6-7. Using Syntex miniplate with 6 screws, fusion of C5-6-7 was achieved. Routine closure of the wound. Smooth postoperative recovery. The power of the upper limbs dramatically improved.

The patient came to the clinic 13-October-2004 with clean wound and the motor power upper limbs normalized with shrinkage of the hypalgesia, but still limping. He was advised to continue medications and physiotherapy to improve the power of both lower limbs.

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.