The patient came to the clinic 04-April-2005 complaining of neck and left shoulder pain for nine months with exacerbation last month with cephalic syndrome.

MRI performed 01-July-2004 showed PCD C5-6 with left partial foraminal occlusion.

On examination: the patient had weak extension of the left hand  the weak left triceps muscle 4/5. The patient had pain when looking up and bending the head to the left with agonizing pain with sleep disturbances due to pain.

The patient managed herself conservatively and was in good condition, until she came 28-August-2008 with severe agonizing neck pain for 2 months shooting to the right upper limb.

MRI of the cervical spine performed 28-August-2008 showed de novo PCD C6-7 with occlusion of the right foramen and shrinkage of the previous disc at C5-6.

On examination: the patient in agonizing pain, preventing her from sleep for several days. There is weak grip and extension of the right hand and the right triceps muscle -4/5. There is numbness of the entire right hand with hypalgesia of the median territory of the right hand.

Anterior approach with discectomy of C6-7 was done under image-intensifier. The extruded material was removed in several pieces.

Routine closure of the wound and smooth postoperative recovery with normalization of the power of the right upper limb.

The patient was treated conservatively 2005 for the first extrusion of C5-6 and the extrusion disappeared in the new performed MRI.

Surgery as in this case was the only option, since she was not responding to conservative measures and she was urging for surgery.

Simple discectomy is the preferred choice of treatment, since there is no signs of instability.