The patient came to the clinic 29-January-2013 complaining of neck and right upper limb pain for 3 years with exacerbation of the left upper limb pain the last 45 days with numbness of the left hand and cephalic pain. The patient cannot sleep due to pain. The patient underwent laminectomy for LCS 13 years ago and she is hypertensive for 5 years.

MRI cervical spine done 22-June-2011 showing extruded disc C4-5  and C5-6.

On examination: The patient have weak grip left hand 4/5, extension left hand 3/5, and left triceps muscle 4/5. She has decreased hearing with tinnitus left ear for three years. SLRS was 70 degrees with pain in the right with weak dorsiflexion right foot 4/5.

The patient was sent to perform MRI of the cervical and lumbar spine, which was done 29-January-2013 showing severe cervical canal stenosis with extruded disc C4-5, 5-6 and to lesser degree the C6-7. There is also severe LCS L2-3, L3-4, L4-5 and L5-S1.

Discectomy C4-5 and C5-6 with total cleaning until the dura was seen behind the bodies of C4, C5 and C6. Fidji cervical cage 15x12x6.9 mm was inserted to C4-5 disc space and 12x15x6.1 mm to the C5-6 with NovaBone. Fusion of C4-5-6 was done using Trinica cervical plate 42 mm length with 2 fixed screws  14x4.2 mm length to C5 and variable to C4 and C6  same length. All stages of surgery were done using C-arm.

Routine closure of the wound. Smooth postoperative recovery. The power of upper limbs became normal.

The patient has extruded disc C4-5 C5-6 with spinal cord compression, more to the left. Decompression and fixation must be achieved. It was decided not to violate the C6-7 level.