The patient came to the clinic 14-November-2007 complaining of LBP for 4 years and four limb pain for 6 months with neck pain with weak both upper limbs for 2 months and difficulty in walking for the same period.

MRI of the brain showed chronic sinusitis with scattered small lacunar infarcts both cerebral hemispheres and partially empty sella. MRI cervical spine performed 13-November-2007 showed spondylolisthesis C3-4 and C5-6 with fusion of C4-5 and malacia of the spinal cord at C3-4 level. There is an old osteophytic mild extrusion of C6-7 left side of no clinical importance.

On examination: The patient has weak both deltoids 4/5 and left biceps brachii 4/5 and both hands grip 3/5 and extension 3/5 right hand and 4/5 left hand with weak triceps right 3/5 and left 4/5. There is hypalgesia right C4 and 5 territories. Hoffmann sign positive both sides and Lhermitte's sign positive when flexing the neck. Deep tendon reflexes all were exaggerated in both upper limbs and lower limbs with Babinski positive both sides with weak planterflexion both feet and hypalgesia of the left leg below the knee.

Discectomy of C3-4 was performed and drilling of the anterior osteophytes of C4-5 was performed and using the Hybrid Reflex miniplate and screws were applied to fuse the C3 down to C6 bodies with traction of 12 Kg applied and reduction of the spondylolitic elements achieved by the three level construct. Image-intensifier was used in all steps and Inomed Highline ISIS left carotid scenario was used for iom.

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

Cervical canal stenosis is a progressive disease and if it is showing deteriorating course surgery is mandatory to prevent further damage to the neural tissues.

In this case the mobile segments of C3-4 and C5-6 with the C3-4 extrusion were playing more major deleterious effect in the spinal cord and decompression with fixation of the mobile segments was more important than the stenosis.