The patient  came to the clinic 25-March-2012 complaining of four limbs numbness and pain with weak four limbs after RTA 1 year ago. The patient claiming that his condition is deteriorating the last months with difficult walking.

MRI cervical spine performed 24-March-2012 showing extruded disc C3-4 with malacia of the spinal cord at this level with cervical canal stenosis C5-6, C6-7 due to extruded disc at these level.

On examination, the patient has shuffling gait for 2 months with hypalgesia below C3 both sides. There is profound weak four limbs more the left side. Hoffman positive both sides. The patient has Lhermitte's sign when looking up with pain. SLRS was 30 degrees due to weakness.

The patient was sent for another MRI of the cervical spine and brain , which were done 26-March-2012 showing extruded disc C3-4 with malacia of the spinal cord and severe stenosis C5-6, C6-7 levels due to disc compression with no compression from the posterior elements.

Discectomy C3-4 and C5-6 until the dura was seen at the entire posterior border of the disc space. Fidji cervical cage 12x17x6.1 mm inserted to C3-4 and 12x17x5.3 mm to the C5-6 disc spaces with NovaBone. The calcified annulus fibrosis of C6-7 was removed partially to inspect the C6-7 disc space. There was practically no disc material and complete collapse of the disc space, for what it was decided not to include the disc space for violation since it is already fused. Using Trinica 3 level plate 60 mm length, fusion of C3-4-5-6  was achieved using fixed screws to C4 and C5 14x4.2 mm and variable screws 14x4.2 to the C6 body and right side of C3. The left side was fixed with variable screw 14x4.6 mm. Check image-intensifier was used at all stages of surgery. The construct was slightly shifted to the left at the inferior border, which was considered acceptable.

Routine closure of the wound. Smooth postoperative recovery. The power of the four limbs became dramatically better.

The patient has severe compression of the spinal cord with malacia of the spinal cord at C3-4 with progressive course. All the compressive elements must be eliminated to stop the deteriorating course of the patient.

It was plan before surgery to include the C6-7 disc, but during surgery, this disc was absent and fused, for what it was ignored from calculations.

The patient came 26-May-2012 showing full recovery of his neurologic deficits.