The patient came to the clinic 20-April-2015 complaining of numbness four limbs for 10 months. He noticed slight improvement, than after 2 months got deterioration with ataxic gait and feeling tightness of the whole body. MRI lumbar spine done 09-October-2014 showing bulge L4-5. Cervical MRI bad quality showing PCD C4-5 with gross malacia of the spinal cord. MRI dorsal spine done 15-April-2015 showing bulge D7-8.

On examination: the patient is limping as dragging both lower limbs. Romberg test : the patient swaying to all directions.  There is mild pain when turning the head down and bending the head to the left shoulder. The biceps are 5/5, but the grip, extension and triceps both upper limbs -3/5. There is weak dorsiflexion both feet -4/5 both feet and planterflexion right foot 4/5. There is hypalgesia both hands median distribution. Hoffmann test positive both sides. The deep reflexes are exaggerated all over. The 2 point discrimination was lost in the left leg.

The patient was sent for new investigations with thorough protocol to rule out MS of the CNS and to have better idea about the spinal cord problem. These were done and the brain was normal and there was a very huge disc C4-5 with severe compression of the spinal cord with malacia of the spinal cord at the level of compression. There is a bulge of C7-D1 of no clinical significance.

Using the C-arm, the level of C4-5 was identified and discectomy of C4-5 was achieved until the dura was seen all over. 1 Solis cage 5 mm was inserted to the disc space with bone graft. Reflex 1 level plate 18 mm length with 4 fixed 4x16 mm screws were used to fuse C4-5. All stages of surgery were done with C-arm control.

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

The patient motor recovery was immediately after surgery.

In the previous investigations due to bad quality MRI there was discrepancy between the massive malacia of the spinal cord and the non convincing spinal cord compression, which led us to perform new investigations to rule out MS or transverse meylitis and to demonstrate the big extrusion of C4-5.