The patient came to the clinic 25-May-2010 complaining of severe neck pain for 5 days with left shoulder and cephalic pain and numbness of the thumb right hand.

MRI of the cervical spine performed 25-May-2010 showing huge extruded disc C5-6 with left up and downward migration with malacia of the spinal cord with occlusion of the left foramen.

On examination: there is pain and limitation of neck movement when in flexion. The grip and extension of the left hand is 3/5 with weak left triceps muscle 4/5.

Discectomy of C5-6 was performed with removal of the extruded parts of the disc. TES=MEP protocol of IOM was used and C4-C3 with anode at C4 was used. The current at 30 mA was producing twitches of the left side of the face. Only currents of 180 mA were necessary to achieve the EMG response of the left thenar muscle. Prestige LP cervical system 5X16 mm dimensions was used and several checks using image-intensifier were performed for the control of proper position and function of the device.

Routine closure of the wound and smooth postoperative recovery with improvement of the power of left upper limb.

The patient had large extrusion with possibility to widen the posterior edges of the lower part of C5 and upper part of C6 so as not to escape the migrating fragments.

In this case it is preferable to use the cervical system such as the Prestige-LP to regain the maximum more or less normal movement of the segment, to prevent future escalation of extruded disc above and below the lesion.