The patient came to the clinic 20-December-2017 complaining of numbness four limbs for 3 weeks. Bad MRI cervical spine performed 17-December-2017 showing huge extruded disc C4-5, C6-7 with spinal cord compression more from the right side with malacia of the spinal cord at the C4-5 level.

On examination; the patient is limping, with weak extension of the right biceps 4/5, both hands flexion -4/5, extension hands -3/5 with inability to extend both hands fingers and triceps both arms 3/5. Hoffmann positive both sides. There is hypalgesia for pin brick below both L2 roots territories. There is weak dorsi and planterflexion both feet  4/5, more week at the right. SLRS was 60 degrees both sides with weak right quadriceps, The deep reflexes are exaggerated in the right side with Hoffmann signs positive both sides and Babinski positive in the right. There clonus both feet more brisk at the right.

The patient was sent for investigation and proper MRI done 20-December-2017 showing huge extrude disc C4-5 with bilateral compression of the spinal cord, more the right and an old calcified extrusion C6-7 left side. Dynamic studies were normal and CT-scan of the cervical spine showed the ossification of C6-7 left side.

Discectomy C4-5 until the dura was seen at both sides. ON PLUS (EOS) Cervical bladed cage 14x17 H7 with IN'OSS 2x0.5 ml inserted to C4-5 level.  Routine closure of the wound.

Smooth postoperative recovery. The power of four limbs improved dramatically. He was sent to the ward.

The patient having severe stenosis of the cervical spine with malacia of the spinal cord with sudden onset deterioration the last 3 weeks. Surgical decompression of C4-5 is the best solution to prevent further deterioration and the old calcified extrusion of C6-7 was left untouched.

Here the compression is from anterior, for what anterior approach is performed.