The patient came to the clinic 16-Ocotber-2001 complaining of progressing weakness of four limbs, numbness both hands, more the right  with dyspnea the last 2 months. The patient due to falling down 31-July-1990 got fracture C5 with complete paraplegia, for what surgical correction and stabilization done at KHMC immediately after insult, with partial recovery over several months. Conservative treatment was recommended. The patient then came 25-January-2010 complaining of deterioration of his walk. The hypalgesia below C4 disappeared, but there is weak grip and extension right hand 2/5, triceps right arm 3/5 with weak quadriceps right leg 3/5, abduction and adduction of the right knee 4/5, planterflexion and dorsiflexion right foot 3/5. MRI cervical spine performed 17-January-2010 showed huge extruded disc C3-4 with spinal cord compression. Discectomy with fusion was advised and he underwent surgery in Germany.

The patient then came 25-July-2013 complaining of weak four limbs with general weakness and difficult walk the last 3 months with dyspnea and intrascapular pain with left sciatica.

On examination: the patient is limping with exaggerated scoliotic stance. There is pain when turning the head to the right down and up and bending the head to both shoulders. The power of the right upper limb the same as before and there is weak grip and extension of the left hand. The weakness of the right lower limb more pronounced than before, and there is weak dorsi and planterflexion left foot 4/5. The right lower limb is spastic and Babinski and Hoffmann signs were positive and brisk both sides. Clonus both feet, more pronounced in the right side. MRI cervical spine performed 15-June-2013 showing huge PCD C6-7 with severe compression of the spinal cord at this level. The spinal cord has gross malacia all over the cervical spinal canal. MRI lumbar and dorsal spine done also showing bulge D6-7, D10-11, L4-5 and L5-S1. Cervical X-ray done 25-July-2013 showing a cervical disc system inserted to C3-4 with calcification around it. Fusion of C4-5-6 in one bone.

Discectomy C6-7 with removal of the bone elements compressing the spinal cord. The dura was seen all over the removed disc posterior borders. Insertion of Fidji cervical cage 12x15x6.9 mm with NovaBone. Using Trinica cervical plate 24 mm length, fusion of C6-7 done with three fixed screws 16x4.2 mm and one 14x4.2 mm to the left side of C6 body. C-arm was used at all stages of surgery.

Routine closure of the wound. Smooth postoperative recovery.

The patient after fusion of C4-5-6 progressed over time extruded disci at near by segments. C3-4 was treated 2 years ago and now C6-7 required surgical correction.