The patient came to the clinic 01-November-2012 complaining of neck pain for 25 years with exacerbation the last year with both shoulder pain more the right. She has also LBP with left sciatica for 4 years. She has urinary problems for 4 years. MRI of the left knee done 11-October-2012 showing effusion of the left knee.

On examination: the patient is limping due to left sciatica with exaggerated scoliotic stance. There is weak grip and extension of the right hand and the right triceps muscle 3/5. There was hypalgesia of the thumb of the right hand. SLRS was 90 degrees both sides without pain and there is weak dorsiflexion left foot 4/5.

MRI of the cervical spine done 04-November-2012 showing wide-based extrusion of C5-6 with bulge disci C4-5 and C6-7. MRI lumbar spine showed small extruded disc L5-S1 more to the left.

The patient then came 15-December-2012 complaining of both upper limb pain with neck pain when looking to all directions with weak both upper limbs. The patient was seen by cardiologist, confirming there was no cardiac problems. The left sciatica increase the last 2 weeks and new MRI of the lumbar spine was the same as before.

The patient was sent for new MRI of the cervical spine which was done the same day and it was the same as before.

Discectomy of C5-6 with removal of the extrusion until the dura was seen at all the posterior aspect. A Fidji cervical cage 12x15x5.3 mm was inserted to the disc space with NovaBone Putty CMP. Using cervical plate Zimmer 22 mm one level  with 4 fixed screws 4.2x14 mm, fusion of C5-6 was achieved. All steps were done under C-arm control.

Routine closure of the wound. The power of the upper limbs became normal.

The patient has wide-based extrusion of C5-6 with secondary canal stenosis. There is no malacia but irritation of the anterior spinal artery could provoke the clinical data of myelopathy without the presence of malacia.