The patient admitted to Shmaisani hospital flying from Kuwait 07-September-2012 complaining of neck pain and both shoulder pain and weak right upper limb and inability to walk for three years. She is using walker and crutches for three years. The patient is a known diabetic with arterial hypertension.

MRI cervical spine done 27-May-2012 showing PCD C4-5 and C5-6 compressing the spinal cord. MRI lumbar spine done 02-March-2011 showing severe lumbar canal stenosis L1-2, L2-3, L3-4 and L4-5. MRI of the cervical spine repeated 06-September-2012 showing extruded disc C4-5 and C5-6.

On examination, the patient is unable to walk with pain when looking to all directions with frozen both shoulders and profound weak right upper limb 3/5 with exception of the right biceps and deltoid muscle. The extension of the left hand and the left triceps are weak 4/5. There is no sensory deficit. There is drop left foot with weak planterflexion 3/5 and weak dorsi and planterflexion right foot 3/5. There is hypalgesia of the right foot above the ankle joint.

Discectomy C4-5, C5-6 with osteophytectomy. Cervical cage with bone graft 15x12x4.5 mm inserted to both disc spaces. Fusion of C4-5-6 was achieved by Trestle cervical plate 30 mm length and insertion of fixed 14 mm to the left C5 body and rescue fixed to the right side. 3 variable screws 4x14 mm were used to C6 and right side of C4. One variable rescue screw was used to the left side of C4. All stages of surgery were performed using C-arm.

Routine closure of the wound. Smooth postoperative recovery and the power of right upper limb dramatically improved, so the distal muscles of the left upper limb and the left triceps. The patient is complaining of left shoulder pain and profound weakness of the left biceps and deltoid without sensory deficit.

The patient have 2 major problems in the cervical and lumbar spine. Resolution of the cervical problem take precedence in time.

Correction of the lumbar problem will be achieved after 4-6 months after resolution of the cervical problem.

We usually apply traction to the shoulders and the patient has frozen shoulders. Even knowing that and slight traction was applied to have acceptable lateral views of the cervical spine, but this procedure triggered problem to the left shoulder, which needs time to recover.