The patient came to the clinic 22-July-2018 complaining of difficult walking only with crutches for 4 years and the last 6 months in wheelchair. She has numbness four limbs more the left with neck and both shoulders pain more the left for 1 year. MRI cervical spine performed 07-September-2017 showing PCD C3-4, 4-5 with malacia of the spinal cord. Lumbar spine MRI showed LCS L2-3, 3-4 and 4-5. The patient is a known hypertensive with diabetes mellitus under treatment and receiving Baby aspirin.

On examination: the patient in wheelchair. There is weak both biceps muscles 4/5, grip, extension right hand and right triceps -4/5. The left side were 4/5. Dorsiflexion right foot -3/5, left 3/5, planterflexion both feet 4/5.There is hypotrophy of the thenar right hand. Hoffmann was positive in both sides. DTR S>D.

The patient was sent for investigations and MRI cervical spine done 22-July-2018 showing the same extrusions with spondylolisthesis C3-4  and malacia of the spinal cord. Dynamic studies confirmed the spondylolisthesis C3-4. The patient was advised to be evaluated by cardiologist and pulmonogist.

Transnasal intubation. Discectomy C3-4 and C4-5 until the dura was seen at the posterior edges of the disc cavities. Insertion of ASPEN cervical cages 14x16x6.5 to both disc cavities with bone graft. Fixation of C3-4-5 using OSI cervical plate 44 mm length with 6 screws 16x4 mm.  Routine closure of the wound.

Smooth postoperative recovery. The power of the four limbs became normal. She was sent to the ward.

The has severe compression at both levels with spondylolisthesis C3-4. Decompression and proper fixation of C3-4-5 is the ideal solution.