The patient had RTA 6 years ago with neck pain which recovered after several weeks. The last three months got neck pain with unsteady gait with pain and paresthesia both upper limbs for 2 months with weak both upper limbs more the left. MRI cervical spine performed 03-May-2016 showed severe cervical stenosis C3-4 with malacia of the spinal cord. Dynamic studies showing spondylolisthesis C3-4. MRI lumbar spine performed 12-July-2016 showing bulge diski L4-5 and L5-S1.

On examination: the patient has unsteady gait with Romberg test falling to all directions. There is atrophy of the interossii right hand with Hoffmann sign positive right side. There is hypalgesia below C3 both sides with preservation of sensation of the left leg below the left knee. There is weak biceps, triceps, flexion and extension of the hands both upper limbs -4/5.

The patient was sent for repeat MRI of the cervical spine with dynamic studies and cardio consultation. MRI performed 25-July-2016 confirming the above mentioned data with malacia of the spinal cord and dynamic studies confirmed the spondylolisthesis. The patient stopped anticoagulants for 6 days before the surgery.

Diskectomy C3-4 with osteophytectomy was performed until the dura was seen glistening all over the posterior aspect of the disk space. Step wise widening of the disc space was perfumed until Samarys RF cage 15x12x7 mm was inserted. Using anterior cervical plate one level 18 mm with four fixed 16x4 mm, fixation of C3-4 was achieved. All stages of surgery were guided with the C-arm.  Routine closure of the wound.

Smooth postoperative recovery. The power of both upper limbs dramatically improved and the patient was sent to the ward.

The patient has spondylolisthesis with severe stenosis and malacia of the spinal cord at C3-4. The sooner the surgical correction the better the outcome.