The patient came to the clinic 11-September-2004 complaining of neck pain for 7 months with numbness median distribution both hands. He was operated elsewhere for right CTS without effect. His condition is deteriorating. MRI cervical spine done 05-June-2004 showing spondylolisthesis C3-4 with compression of the spinal cord with bulge C5-6. MRI cervical spine repeated 12-August-2004 showing worsening of the C3-4 area.

On examination, the patient in pain, having neck pain when turning the head to the right. The patient walking shuffling, limping. There is severe weak grip and extension both hands 3/5 and both triceps muscles 3/5, so the deltoids and both biceps brachii 4/5. There is hypalgesia of the hands both sides. Hoffman positive both sides with exaggerated deep reflexes four limbs. There is weak muscles both lower limbs. Babinski positive both sides.

Using the C-arm, the level of C3-4 was identified and discectomy of C3-4 was performed and the extruded pieces were removed until the dura was seen at the bottom of the removed disc cavity. Using Scientx one level miniplate, fusion of C3-4 was achieved. Routine closure of the wound. Smooth postoperative recovery. The power of the four limbs dramatically improved.

The patient came to the clinic 22-September-2004 with clean wound and more neurologic improvement. Check X-ray showed good alignment of the construct.

The patient came several times with further improvement, then he came 26-April-2008 complaining of LBP with left sciatica. MRI lumbar spine performed 27-July-2007 showing elements of lumbar canal stenosis. The patient was sent for cervical check up and the right upper screw was out 10 mm, but not bothering him.

The recurrence rate in cervical disc surgery is zero. Another disc can cause de novo extrusion. When instability is the main cause, fusion is a must.