The patient came to the clinic 23-September-2010 complaining of neck pain for 1 year with both upper limbs pain and numbness four limbs with exacerbation the last 2 weeks. Cath was done 2006.

MRI cervical spine performed 20-September-2010 showing PCD C5-6 compressing the spinal cord and to lesser degree the C4-5 with left partial foraminal occlusion.

On examination: The patient has severe pain and limitation of neck movement to all directions. The grip and extension and triceps of both upper limbs are 3/5. There is hypalgesia of the middle finger left hand. There is weak dorsiflexion both feet  and quadriceps muscles both lower limbs 4/5.

Discectomy of C4-5 and C5-6 was performed until the dura was seen, so as not to miss any compression. Fidji cages 17X6.9X12 mm inserted to C4-5 level and 17X6.1X12 mm to C5-6 with Novabone. Trinica 44 mm 2 level cervical plate was used to obtain fusion of C4-5-6 with 6 screws 14X4.2 mm. All stages of surgery were performed under image-intensifier guidance. 

Routine closure of the wound and smooth postoperative recovery and the power of all limbs became normal.

The patient had tetraparesis, which resolved immediately after surgery. This means that parabiosis of the neural tissues was the leading factor for such neurological deficit.

The fusion with cage implementation is the ideal option, because inserting 2 cervical disc systems, first it is costly and second: it has the disadvantage of possible slipping.