The patient came to the clinic 30-July-2008 complaining of walking difficulty for three years. Deterioration the last 10 months in wheelchair.

MRI done 20-July-2005 showed PCD C4-5 with OPLL C5-6 and C6-7.

On examination: the patient unable to stand to evaluate the scoliotic stance, the tongue protruding to the left. Hoffmann positive both sides with hypalgesia starting from the left V2 division down to include the left upper and lower limbs. Flexion both hands 4/5, extension both hands 3/5, both biceps brachii 4/5 and deltoids 4/5, the right triceps 2/5 and the left 4/5. All muscles lower limbs were weak 4/5. Babinski was positive in the right with more spastic pattern of the right lower limb and bilateral clonus.

The patient was sent for MRI of the brain and the cervical spine, which ruled out the presence of brain stem infarctions and the presence of severe malacia of the spinal cord at C4-5 level with severe compression of the cervical spine at this level with lesser degree at C5-6.

Discectomy of C4-5 with meticulous cleaning of all osteophytes and disc material compressing the spinal cord, until the dura was free from the far left to the far right side. Decompressive discectomy of C5-6.  Using miniplate 2 levels with 6 screws, fusion of C4-5-6 was done. Using the milling machine of Midas Rex the bone harvested during surgery was milled and applied to the empty spaces.

Routine closure of the wound and smooth postoperative recovery with improvement of the power of four limbs.

The patient had severe compression of spinal cord at C4-5 level with malacia of the spinal cord. After decompression the neurological status improves, but this result must not be promised to the patient before surgery, because the main aim of surgery is to stop the process of deterioration.

The disc space of C6-7 was very shallow with actual fusion of both bodies, for what it was not included in the fusion process, taking into consideration, the age of the patient.