The patient came to the clinic 23-April-2008 complaining of headache left fronto-temporal region for 5 months with neck pain and left upper limb pain with numbness.

On examination at that time, she had weak grip, extension left hand with hypalgesia left median nerve territory.

MRI cervical spine done 24-April-2008 showing extruded disc C5-6 and C6-7 small in size more to the left. MRI of the brain showed hyperostosis frontalis interna. The patient was treated conservatively.

The patient, then came 25-October-2008 complaining of right sciatica down to right S1 territory for several weeks with hypalgesia right L5 and S1 roots. There was mild scoliotic stance and MRI performed 23-October-2008 showing bulge L4-5 and L5-S1 disci. She was treated conservatively.

The patient then came 13-February-2012 complaining of agonizing neck  and right shoulder and right upper limb pain for 12 days with exacerbation the last 6 days. She cannot sleep due to pain. despite the fact she is receiving massive doses of pain-killers.

On examination, the patient cannot turn the head to both sides and downward. There is weak grip and extension right hand 3/5 and the right triceps power 3/5. There is hypalgesia of the entire right hand.

MRI of the cervical spine with myelography was performed 13-February-2012 showing huge extruded disc C6-7 with complete right foraminal occlusion and small disc C5-6 more to the left.

Discectomy C5-6 and C6-7 with removal of the migrating fragments to the right foramen and extradural inspection for any remnants. Fidji 6.9x12x15 mm cage inserted to the C6-7 level. Fidji 5.3x12x15 mm cage inserted to the C5-6 level, both with NovaBone. At the start Trinica 2 level 36 mm plate inserted, but it was short, for what another one 38 mm length was used to fuse C5-6-7 levels. Trinica fixed screws 14x4.2 mm were used to C6 and variable 16x4.6 mm to the C5 level and variable 16x4.2 mm to the C7 level. All stages of surgery were guided with C-arm.

Routine closure of the wounds. Smooth postoperative recovery with normalization of the power of right upper limb.

The patient has protracted history, with old small extrusion C5-6 and huge recent extrusion C6-7. Discectomy of both levels was necessary to avoid possible escalation of events at C5-6 in case if fusion was limited to C6-7 level.