The patient came to the clinic 13-January-2013 complaining of both upper limbs pain and numbness more the left hand for 2 months with left lower limb pain and numbness. The patient is a known diabetic for 10 years and underwent CABG 7 years ago.

MRI cervical spine done 14-January-2013 showing extruded disc C3-4, C4-5 with severe segmental stenosis and malacia of the spinal cord with elements of OPLL. MRI lumbar spine done 04-June-2012 was not significant.

On examination: the patient using crutches for one month limping with shuffling gait. There is pain when turning the head to both sides more to the left and looking upward. The left biceps muscle is weak 4/5. Grip both hands 4/5, extension both hand 3/5, right triceps -4/5 and left 2/5. There is hypalgesia left hand and right die of the body below Th2 and the left leg below the knee. SLRS was 70 degrees both sides. There is weak dorsiflexion both feet 4/5 and the left quadriceps 4/5.

Discectomy of C3-4 and C4-5 with osteophytectomy until the dura was seen lax at the whole entire posterior border of the posterior edges of the bones. A Samarys cervical cage 5x13x17 was inserted to the C3-4 level and 6x13x17 mm to the C4-5 level. Using Trestle anterior cervical plate 30 mm length 2 level was used to fuse C3-4 and 5. 2 variable screws 4x14 mm were used to the C3 body, 4x14 mm fixed to the C5 body and 4x14 mm fixed to the right side of C4 and 4.5x14 fixed to the left side of C4. All stages of surgery were C-arm guided.

Routine closure of the wound. Smooth postoperative recovery. The power of the right upper limb and feet became normal. Improvement of the power of the left upper limb.

The patient has severe cervical canal stenosis and extruded disc C3-4 and 4-5 with stenosis and elements of OPLL. The condition is deteriorating and surgical correction is the only solution to prevent further deterioration.