A 55-year-old African man presented to our Orthopedic Spine Outpatient clinic at our institution at the Bone and Joint Institute of Hamad General Hospital (largest tertiary care facility in Doha, Qatar) with a chief complaint of neck pain since 5 months and weakness of his right foot in the last 2 weeks. History revealed that the neck pain was aggravated with any neck bending activities, and associated with pain and numbness radiating to right arm up to the index and middle finger. Bowel and bladder function were normal, and there was no myelopathic symptoms. Two weeks prior to this presentation, the patient had developed right lower limb radicular pain, numbness, and weakness of the right foot, with no symptoms of back pain. His general medical history included hypertension diagnosed at the age of 50 and treated with medications. The patient is a non-smoker, and no other significant diseases were noted in his general medical history. There was no relevant past surgical or family history. Upon clinical neuro-examination, both upper limbs had normal tone, and the power on the right upper limb was grade 3/5 Medical Research Council (MRC) [] for C7 myotomes. There was subjective decreased sensation of pain and light touch for the right and left C6 and C7 dermatomes, increased right C7 hyperflexia, positive Spurling test, negative Lhermitte sign, and negative shoulder abduction test. Neuro-examination of the lower limbs showed that the patient had a right high steppage gait and normal tone bilaterally. On the right side, the power of right dorsiflexion was 2/5, extensor hallucis longus was 2/5, and plantar flexion was 5/5. The power of the other muscle groups of both lower limbs was normal. The ankle reflex was normal bilaterally, and right knee reflex was 3+. Babinski's test was positive on the right side but negative on the left side. Sensation to pain and light touch was declined on the right L4 and L5 dermatomes, and the straight leg raising test was negative. Neuroimaging was performed. X-ray of the cervical spine showed multiple vertebral osteophytes as well as disc degeneration, mainly at the C5-C6 and C6-C7 levels, with kyphotic deformity () and stable cervical vertebrae (). CT scan depicted no calcified posterior longitudinal ligament (). Magnetic resonance imaging (MRI) of T2 showed significant disc herniation encroaching on the spinal canal mainly at the C5-C6 and C6-C7 levels, with no spinal cord signal changes (). MRI of the lumbar and thoracic spine revealed mild disc degeneration at L3–L4 and L4–L5 (), with no major disc herniation or nerve root impingement, which seemed to be inconsistent with the degree of clinical presentation of the FD. The decision was to undertake anterior cervical decompression and fusion (ACDF) at C5–6 and C6–7. Four days after the initial presentation at our clinic, the procedure was undertaken by an experienced consultant spinal surgeon under general anesthesia. The procedure comprised a right sided anterior approach of cervical spine, C5–6 and C6–7 discectomy and interbody fusion using trabecular stand-alone cages, and insertion of wound drain that was kept for 24 h. There were no intra or postoperative complications, and two days postoperatively, the patient had complete and dramatic recovery of his right foot drop. He was discharged on postoperative day 3. The follow up course went smoothly, and follow up x ray was satisfactory (). The patient was followed up for one year. He resumed his normal ordinary activity with satisfaction.