The patient came to the clinic 08-August-2014 complaining of neck pain for 15 years. The last 3 years started to complain of weak right leg and left upper limb, then numbness the four limbs. MRI cervical spine done 01-May-2012 showing severe stenosis of C4-5, 5-6 and C6-7 with malacia of the spinal cord with possible retrolisthesis C5-6 and C6-7.

On examination, the patient was unable to stand for Romberg positioning. He was limping with some scoliotic stance. There is severe hypotrophy of interossii both hands with severe weakness both upper limbs: the grip right hand was 5/5, the left 3/5. Extension right hand 4/5, the left 2/5. The right triceps muscle power 2/5, the left -2/5. There is hypalgesia both upper limbs. Hoffmann was positive, more brisk in the right side. SLRS was 40 degrees right side and 30 degrees left with tightness. The deep tendon reflexes were exaggerated more in the right leg with Babinski both sides. There is weak dorsiflexion both feet -4/5 and planterflexion right foot -4/5. There is weak right quadriceps muscle 3/5 and the left 4/5. The sensation for pin-brick, temperature, fine touch, position sense both legs were preserved. There is spasticity of the right lower limb.

The patient was sent for new investigations and MRI of the cervical spine performed 08-August-2015 confirmed the presence of the mentioned above stenosis and severe malacia of the spinal cord. Dynamic studies ruled out the presence of overmobility, instead there is ossified fusion of C3-4, 4-5, 5-6 and C6-7.

Decompressive laminectomy C4-5-6-7 with lower third of C3. There was no epidural fat due to severe compression and the dura bulged after decompression. Routine closure of the wound.

Smooth postoperative recovery. The power of four limbs improved dramatically.

The patient has severe malacia of the spinal cord. Recovery is quarried after decompression.

The aim of surgery to prevent escalation of the neurologic deficit.