The patient came to the clinic 08-June-2014 telling that she underwent surgery for PLD L4-5  17-February-2013 for drop left foot at Jordan Hospital. The patient showed considerable improvement after surgery. 4 months later got right sciatica for what MRI performed 08-May-2014 showing recurrence of the disc of L4-5 with upward migration.

On examination; the patient was limping, using crutches with exaggerated scoliotic stance. There is weak grip and extension right hand -4/5 and the right triceps muscle. Weak right quadriceps 4/5, dorsiflexion right foot -3/5, planterflexion right foot -4/5, dorsiflexion left foot 4/5. SLRS was 30 degrees with pain in the right.

The patient was sent for new investigations, which were performed 25-June-2014: Brain MRI not complete study, but normal, MRI cervical showing huge extruded disc C5-6 with severe compression and malacia of the spinal cord.

The C5-6 level identified. Discectomy C5-6 with removal of all extrusion until the dura was seen at all entire resected posterior longitudinal ligament. Samarys cervical cage 17x13x5 mm was inserted to the disc space. Trestle cervical plate  one level 16 mm with with three screws fixed 4x14 and one screw 4.5x14 mm were used to fuse C5-6. The revision screw was used to the left upper corner. All stages of surgery done with C-arm control. Routine closure of the wound.

Smooth postoperative recovery. The power of the right upper and lower limb became normal. The power of the left foot improve slightly.

The cervical lesion takes precedence over the lumbar spine. The severe compression of the spinal cord must be corrected before discussing the lumbar area.