The patient came to the clinic 20-November-2017 complaining of numbness of the right upper and lower limbs, more from the right nipple downward for 7 years with numbness both hands. MRI cervical spine performed 08-November-2017 showing extruded disc C4-5, C5-6 with spinal cord compression more from the right side with malacia of the spinal cord at the C5-6 level. Lumbar MRI showed bulge L4-5 and L5-S1.

On examination; the patient is not limping now, with weak extension of the hands and triceps both arms 4/5. Hoffmann positive both sides. There is hypalgesia for pin brick from 10 cm above the right nipple right side. 

The patient was sent for investigation and cardio evaluation.

Discectomy C4-5 and C5-6 until the dura was seen at both levels. Osteophytectomy of the C5-6 level. Cervical cages 7 x05 inserted to both levels. Using Precision Spine  ACDF 46 mm 2 level with 4 variable 4x16 mm to C4 and C6 and 2 fixed same dimensions to C5 were used to fix C4-5-6.  Routine closure of the wound.

Smooth postoperative recovery. The power of the right upper limb normalized. The power of the left hand and left leg deteriorated immediately after surgery. He was sent to the ward.

The patient showed full blown left sided Brown-Sequard syndrome, which over several hours started to recover. Control MRI done at 9.00 p.m. showed no compression and the spinal cord hanging free with the previous malacia, which will be morphologically permanent. The next day, the patient could walk with help and could move the upper and lower limbs. It was explained to the patient that, this phenomena can happen and it needs days to fully recover, but the sensory deficit, will partially recover over the years.

The patient having severe stenosis of the cervical spine with malacia of the spinal cord with progressive deterioration. Surgical decompression is the best solution to prevent further deterioration.

Here the compression is from anterior, for what anterior approach is performed.