The patient came to the clinic 01-July-2002 complaining of polyarthralgia for 22 years. CT release both hands and discectomy L4-5 1984 in Cairo. Neck pain  for 5 years. She was operated for PCD 01-April-2002 at KHMC after what she got deterioration: The left upper and lower limbs became weaker with dysesthesia. MRI cervical spine performed 20-March-2002 before the surgery showing bulge C4-5, extruded disc 5-6 and huge extrusion C6-7 with malacia of the spinal cord with compression. The patient is hypertensive under treatment.

On examination: The patient has neck pain when rotating the head to all directions with power of the left hand flexion and extension 0/5, so the left triceps. The flexion and extension right hand 1/5, so the right triceps 3/5. There is hypalgesia below the left C6 level down with left leg.

The patient was sent for investigation: MRI lumbar spine performed 19-July-2002 showing very large extrusion C6-7, extruded disc C5-6 and bulge C4-5 with OPLL and malacia of the spinal cord.

Through anterior approach, using the previous incision and C-arm the level of C5-6 identified and discectomy with osteophytectomy was performed until the dura was seen at the bottom of the created disc space. The same was done to C6-7. Using Scientx three level bended to adapt the curve of the area with 6 screws, fusion of C5-6-7 was achieved.  Routine closure of the wound.

Smooth postoperative recovery. The power of both upper limbs improved. She was sent to the ward.

The patient came to the clinic 13-August-2002 with clean wound and the power of the left hand flexion 5/5. extension 3/5, both triceps 3/5 and other muscles 5/5. The analgesia regressed to the ulnar distribution of the left upper limb.

The cervical disci never recur and when malacia present in the spinal cord recovery take long time to recover, not completely. The spinal cord changes will be permanent without presence of compression.