The patient came from Kurdistan to the clinic 02-July-2011 complaining of agonizing neck and left upper limb pain for two months, shooting to the left scapular region. She had minimal neck pain for 10 years.

MRI cervical spine done 02-July-2011 showing extruded disc C5-6 with left foraminal occlusion and compression of the spinal cord with resulting malacia.

On examination: the patient has limitation of neck movement with pain when looking to left, downward and pain in other directions .She had weak grip and extension left hand -4/5 and the left triceps muscle 3/5 with hypalgesia of the median distribution left hand. She had also weak both quadriceps and the left foot dorsiflexion 3/5 and planterflexion -4/5.

Anterior discectomy of C5-6 was performed with removal of the extrusion, until the dura was seen from the left side. Fidji cage 12x15x6.9 was inserted to the empty C5-6 disc space with 0.5 cc Novabone.  Zimmer Trinica one level plate was used to obtain fusion of C5-6 with 4 screws 4.2x14 mm. Routine checks were done with the C-arm.

Routine closure of the wound.  Smooth postoperative recovery with normalization of the power of the left upper and lower limbs.

The malacia of the spinal cord must push for surgical treatment to avoid further possible deterioration.

Applying artificial disc in this case is less superior, because the patient age and bony changes make its use meaningless.