The patient came to the clinic 10-November-2012 complaining of neck pain for 1 year with exacerbation of pain right upper limb the last 2 months. On examination that time had pain when looking up and down with weak grip. flexion right hand and right triceps 4/5. The patient was sent for MRI of the cervical spine which revealed old extrusion of the C4-5 left side and recent extrusion C5-6 right side with minimal compression. It was decided to treat the patient conservatively.

The patient then came the morning of 21-January-2013 complaining of agonizing pain in the neck and right upper limb for three days with severe weak right hand 3/5 and extension 3/5 and triceps right 3/5 with shooting pain to the right shoulder and inability to sleep due to pain and inability to use the right upper limb. The patient was sent for new MRI cervical spine which showed enlargement of the C5-6 extrusion.

Discectomy of C4-5 and C5-6 was done until the dura was seen along all the posterior aspects. Samarys cervical cage 17x13x5 mm was inserted to C4-5 space and 17x13x6 mm to C5-6 level. Trestle 2 level cervical plate 30 mm length was used  with 4 variable 4x14 mm screws inserted to C4 and C5 bodies and 3 fixed 4x14 mm to C5 body. All stages of surgery were done under C-arm control.

Routine closure of the wound. Smooth postoperative recovery. The power of the right upper limb became normal and the shooting pain disappeared.

The patient has extrusion of C5-6 causing the agonizing pain. The old extrusion of C4-5 was included in the management to avoid future escalation of this weak segment.