The patient came to the clinic 02-October-2012 complaining of neck pain for 1 year with numbness left hand. 4 months ago started to complain of numbness with heaviness both upper limbs more the left with positive cough sign.

MRI of the cervical spine done 30-September-2012 showing huge extruded disc C4-5 and C6-7 with malacia of the spinal cord behind C4-5 level.

On examination, the patient is walking with ataxic gait with tendency to fall down. There is mild scoliotic stance. There is pain when looking to both sides more to the right. There is pain associated with all neck movements. There is weak grip, extension of the right hand 4/5 and left hand -4/5. Both triceps are mildly weak 4/5. There is hypalgesia below the left Th5 level. The right quadriceps muscle is weak 4/5.

Discectomy of C4-5 with removal of the extrusion until the dura was seen at the entire space in the depth of the disc cavity. The disc of C6-7 was cleaned internally. Scientex Alphatec Spine Samarys cervical cage 4.5x17x13 mm was inserted to C4-5 level. Another cage 5x17x13 mm was inserted to C6-7. Using Trestle anterior plate 51 mm 3 level 51 mm length was used to fuse C4-5-6-7. 4variable 4x14 mm screws were used to C4 and C7 bodies and 4 4x14 mm fixed screws to C5 and C6 bodies. Al stages were done under C-arm control.

Routine closure of the wound. Smooth postoperative recovery with dramatic recovery of the power of both upper limbs.

The patient had severe compression of the spinal cord with malacia at C4-5. Only surgical decompression was the only solution. The other levels were included to avoid future escalation of events from other levels.