The patient came to the clinic 21-November-2007 complaining of neck pain for 15 years with right upper limb pain for 18 months. She could not use the right hand with numbness of the right hand. MRI of the cervical spine performed 14-November-2007 showed PCD C5-6 with right foraminal occlusion. The patient had rheumatoid hands. On examination at that time, she had weak grip and extension of the right hand 4/5  and weak right triceps muscle 4/5. It was decided to treat the patient conservatively, because the extrusion was not that big and she had gout and rheumatoid elements.

The patient came several times and the last time. she came 04-January-2009 with dramatic deterioration. The patient beside the weakness start to show hypalgesia of the right thumb.

MRI cervical spine performed 07-January-2009 showed the same extrusion and the right shoulder showed effusion of the right supraspinatus tendon. Uric acid was 7.5 mg/dL. The patient was told to wait and try conservative treatment, but she insisted for surgery.

Discectomy of C5-6 was performed and the extruded piece to the right foramen was removed with osteophytectomy of the bony parts at that site. Routine closure of the wound. Doprofos 2 mg was injected lateral to the glinoid process from anterior.

Smooth postoperative recovery and the weakness of the right upper limb disappeared after surgery.

The patient has several pathological processes, which cannot predict the surgical outcome in this case. It is now early to decide, that the extrusion of C5-6 was the major factor in the pain generation, because Doprofos was injected to the pathological area of the right shoulder.

Even with hesitation of the surgeon such in this case and the insistence of the patient for surgery, the outcome will tell how was more precise in the plan of treatment.

There are some cases when small extrusion compressing the nerve root in the cervical and lumbar area causing an agonizing pain forcing the patient to urge for surgery.