The patient came to the clinic 28-May-2009 complaining of neck pain for 4 years with right upper limb and cephalic pain. Exacerbation the last 2 days. MRI done 30-May-2009 showing PCD C5-6 and C4-5. The patient was advised to continue in conservative treatment and in case of deterioration to consider surgical treatment.

The patient then came 21-February-2010 telling that her condition became worse than before  with weak grip and extension of the right hand 3/5 and right triceps muscle 3/5 with hypalgesia entire right upper limb. Severe pain when rotating the neck to all directions with limitation of movement.

MRI of the cervical spine performed 24-February-2010 showing progression of the PCD C4-5 with occlusion of the right foramen with regression of C5-6 right side.

Total discectomy of C4-5 with removal of the extrusion at the right foramen. Check with contrast of the disc space revealed that the root is free of any fragments. Through tiny hole, intradiscal decompression of C5-6 was performed to prevent future escalation of the old extrusion of C5-6.

Routine closure of the wound.

Smooth postoperative recovery, and the power of right upper limb recovered.

Usually, when performing 2-level discectomy of the cervical spine, it is mandatory to apply fixation to prevent instability. Some times it is possible to cheat the rule by applying total discectomy of the clinically manifesting level and intradiscal decompression of the other level. In this case it is not necessary to apply cervical miniplate.

The surgery was indicated for C4-5 and decompression of C5-6 was precautionary to prevent near future escalation of extrusion of C5-6 disc.