The patient came to the clinic 18-February-2014 complaining of neck and left upper limb pain for 8 years. Exacerbation the last 6 days  with numbness of the II-IV fingers left hand. The patient performed MRI cervical spine 19-June-2013 showing extruded disc C6-7 more to the left with bulge C5-6. MRI lumbar spine was normal, brain -partial empty sella.

On examination; the patient has severe pain and limitation of neck movement when looking to all directions. There is weak grip and extension left hand 3/5. The triceps left arm almost paralyzed 1/5.

The patient sent for MRI of the cervical spine and done 18-February-2014, showing huge extruded disc C6-7 with left foraminal occlusion and bulge C5-6.

Using C-arm, the level of C6-7 level identified. Discectomy of C6-7 with removal of the extrusion, which was occluding the left foramen, even with intradural expansion. The dural defect was about 1 mm. It was closed by piece of muscle. Intradiscal cleaning of C5-6. Using Vitatech (France) a cervical cage 6.5x16 with bone graft was inserted to C6-7 level and 5.5x16 mm to the C5-6 level. Cervical plate 2 level 41 mm length with 4 screws 4x18 mm applied to C5 and C6. 2 screws 4x16 mm were used to C7 level. Fusion of C5-6 and C7 was obtained. All stages of surgery were performed with C-arm guidance. Routine closure of the wound.

Smooth postoperative recovery. The power of left hand became normal and the left triceps became 4/5. The radicular pain disappeared.

The patient had intradural penetration of the extruded disc material. A small piece of muscle was sufficient to resolve the problem.