The patient came from USA to the clinic 07-August-2010 complaining of neck pain, weak both quadriparesis and numbness both upper limbs for 5 years with progressive course.

MRI performed 22-February-2010 showing PCD C3-4, C4-5 and C5-6 resulting in severe cervical canal stenosis.

On examination: the patient has neck pain when looking to all directions with weak deltoids -4/5, biceps brachii 3/5, grip and extension both hands  and triceps 2/5. with weak dorsiflexion both feet 4/5. She had hypalgesia both upper limbs from C3 root territory down to C7 both sides.

MRI investigations were repeated and performed 10-August-2010 showing residual after old left mastoiditis  and stenosis left vertebral artery at its origin with severe cervical stenosis C3-4, 4-5 and 5-6 with malacia of the spinal cord at these levels.

Discectomy of C3-4, C4-5 and C5-6 was performed. Insertion of Fidji cages 15X12X6.9 mm were inserted at the discectomized levels. Using Trinica 3 level cervical plate 59 mm length, fusion of C3-4-5-6 was performed with 14 mm 4.5 mm screws. All stages of the surgery were done with the control of image-intensifier.

Routine closure of the wound and smooth postoperative recovery with slight improvement of the power of four limbs.

The anterior decompression was a must because the extruded disci played the major part in compressing the spinal cord.

The extruded disc of C3-4 was central and compressing the anterior spinal artery caused the clinical picture of anterior spinal artery syndrome.