The patient a Yemeni citizen from Hadramout came to the clinic 28-July-2003 complaining of tetraparesis more pronounced in the upper limbs and the left side with numbness both upper limbs for 2 years. The last 2 months deterioration of weak both upper limbs.

On examination, the patient has neck pain when rotating the head to all directions. There is weak four limbs more the upper limbs. The right deltoid 4/5, the right biceps 3/5, flexion right hand 3/5, left hand 1/5, extension right hand -3/5, left hand 1/5, hypalgesia both lateral side of the forearms. The right quadriceps femoris 3/5, left quadriceps femoris 4/5, adduction left knee 3/5, dorsiflexion both feet 4/5. Hoffman positive both sides, clonus left hand with normal micturition control.

MRI of the cervical spine showed extruded disc C4-5 and C5-6 with severe compression of the spinal cord with malacia of the spinal cord.

Through anterior approach, using the C-arm the level of C4-5 was identified and discectomy of C4-5 and C5-6 was performed with osteophytectomy until the dura was seen glistening lax and free at the bottom of both disci cavities. Using Scientx 2 level plate with 6 screws fusion of C4-5-6 was achieved and checked with the C-arm    Routine closure of the wound.

Smooth postoperative recovery. The patient showed some improvement of his four limbs. He was sent to the ward.

The patient came 13-August- 2003  with clean wound with some more improvement of his neurologic deficit. He was advised to undergo physiotherapy with medications to improve his neurologic status at least for 8-12 months.

The sooner the surgical intervention in such compression of the spinal cord, the better the outcome. The patient came late with protracted course of his disease.