The patient a Saudi citizen, came to the clinic 09-July-2002 complaining of weakness of the left upper limb for 1 year. 2months later weak the right lower limb. The last 3 weeks weak both upper limbs. Using crutches the last 3 weeks with dysesthesia both feet. Exacerbation of neck pain the last 3 weeks.

On examination: The patient has neck pain when rotating the head up and down. Romberg stance: unstable and sway to all directions. He is unable to dress his clothing. The power of both hands flexion and extension 3/5m the deltoids and biceps brachii 4/5. There is hypotrophy both interossii muscles. Hoffman + both sides, so Babinski both sides with weak left quadriceps muscle 4/5. UMN disease or MS was suspected and sent for investigations.

MRI cervical spine showed extruded disc C4-5 with malacia of the spinal cord at this level.

Through anterior approach, using the C-arm the level of C4-5 identified and discectomy with osteophytectomy was performed until the dura was seen at the bottom of the created disc space. Routine closure of the wound.

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

The patient came to the clinic 01-August-2002 with clean wound , still weak grip both hands 4/5 and both deltoids and triceps 4/5.

The patient then came 31-August-2002 complaining of left hip and spasm both upper limbs. The deltoids and biceps brachii still 4/5.

The cervical disci never recur.

In retrospective analysis, dynamic studies must have place in preoperative investigations and in absence of overmobility, it will be more beneficial to decompress the spinal cord from behind, because the stenosis was more from posterior at C3-4 and C4-5 levels. (20-April-2021).