The patient came to the clinic 04-February-2015 complaining of neck pain for 2 years with exacerbation last 2 months with right upper limb pain with numbness all fingers right hand and pain both shoulders. MRI cervical spine done 26-January-2015 bad quality, but showing huge extruded disc C3-4 with right foraminal occlusion and malacia of the spinal cord. The patient underwent stinting  2003 with cover of baby aspirin, concor 5 mg once a day and Lipitor 10 mg daily.

On examination, the patient is in agonizing pain when turning the head to the right and bending the head to the right shoulder. There is weak grip and extension right hand and the right biceps 4/5. The right triceps muscle 3/5. There is hypalgesia ulnar distribution right hand and the right L5 territory. There is weak dorsiflexion right foot  and right quadriceps muscle right leg 4/5. Hoffmann's sign positive both sides.

Using the C-arm, the level of C3-4 was identified. Discectomy of C3-4 was performed until the dura was seen entirely more to the right. 0.3 ml Omnipaque was inserted before the trail of 5 was pushed to the C3-4 space. It was evident that the patient has spondylolisthesis C3-4. Using cage 5 mm height and Atlantis Medtronic plate 27x5 mm with 3 screws 4x15 mm and 4.5x15 mm to the left lower corner, fusion of C3-4 was achieved. All stages of surgery were guided with C-arm. Routine closure of the wound.

Smooth postoperative recovery. The power of the right upper limb became normal immediately after surgery.

The spondylolisthesis was diagnosed only after insertion of the Omnipaque. From this fact we shall use this step as routine for the future surgeries.