The patient was admitted to Shmaisani hospital 10 days ago with clinical history of constipation and LBP and left sciatica and inability to walk and difficulty to set due to severe agonizing pain for one week. The patient had old fracture L1 15 years ago and osteoporosis. The patient was seen by me 3 days ago with LBP and left agonizing sciatica and weak dorsiflexion and planterflexion left foot 3/5.

MRI lumbar spine performed 09-August-2010 showing severe lumbar canal stenosis at L3-4, L4-5 with extruded disc L3-4 left side.

On examination: the patient is bedridden and has basal crepitation of both lungs, for what respiratory therapy was started. The patient was in Clexane 20 mg which was kept.

Decompressive laminectomy of L3 and L4 and partial of L5 with flavotomy of L2-3 was performed. Foraminotomy of both L4 roots was achieved. The dura was thin transparent, that the roots were seen through it.  There was no epidural fat along the whole territory of decompression. The extruded disc of L3-4 was removed from the left side, after what the left L4 root regained relaxed position. The disc space was shallow and it was necessary to make small drilling to remove the intradiscal material, which was minimal. There was no signs of overmobility. Routine closure of the wound.

Smooth postoperative recovery and improvement of the power of left foot.

Lumbar canal stenosis is a progressive disease and decompression must include the recent clinically manifesting themselves and the progressing nearby.  For that reason, decompression was achieved at L2-3, L3-4 and L4-5 levels.

The extruded disc was of small size, but considering that the canal was a stenotic one severe compression was noted.