The patient came to the clinic 25-December-2011 complaining of LBP with agonizing left sciatica and numbness all toes left foot for 7 months and exacerbation the last 5 months. MRI lumbar spine performed 17-July-2011 showing huge extruded disc L4-5 with left downward migration.

On examination, the patient is limping with exaggerated scoliotic stance. SLRS was 70 degrees with pain the left side. There is left sided hemihypalgesia  below C3 level with sight weakness of the both upper limbs more the left and complete drop left foot with weak planterflexion left foot 3/5 and weak left quadriceps femoris 4/5. There is Babinski positive in the left side with exaggerated all deep reflexes and clonus both feet more the left side.

MRI of the brain done 17-January-2012 showing scattered small lacunar infarctions of no clinical significant and severe cervical canal stenosis due to huge extruded disc C3-4, 4-5 and C5-6 with malacia of the spinal cord. It was decided to perform cervical disc surgery first to avoid catastrophic events, if lumbar spine surgery with positioning were contemplated.

Discectomy C3-4, C4-5 and C5-6. Osteophytectomy C3-4 and C4-5 until the dura seen at the entire posterior aspect of the disc spaces. Fidji cages with NovaBone 12x15x6.1 mm inserted to C3-4 and C4-5 levels. Another one 12x15x5.3 mm inserted to C5-6 level. Using Zimmer Trinica cervical plate three level 54 mm length fusion of C3-4-5-6 was achieved with variable screws 16x4.6 mm inserted to C3 and variable 16x4.2 mm inserted to C6 level. Fixed 14x4.2 mm screws used to C4 and C5. All the stages of surgery were guided with C-arm.

Routine closure of the wounds. Smooth postoperative recovery with improvement of the power of three limbs except the left foot.

The patient having major problems in the cervical and lumbar spine. Priority paid to the cervical spine.

The patient has huge PLD L4-5 with left foraminal occlusion. Surgical treatment must be performed after 10-20 days.