The patient came to the clinic 13-September-2010 complaining of LBP for 26 years. The patient progressed agonizing bilateral sciatica the last 15 days more to the left. The patient is a known diabetic.

MRI lumbar spine performed 19-August-2010 showing lumbar canal stenosis L4-5.

On examination: The patient walking with bended position. He has exaggerated scoliotic stance. SLRS was 90 degrees in the left with pain and weak dorsiflexion 4/5 both feet. There is hypalgesia and numbness left L5 territory.

The patient was sent for further investigations, which confirmed the presence of posterior compression due to L4-5 ligamentum flavum hypertrophy. ESR was 31 mm/h.

The patient was advised to keep in conservative treatment, but he refused such suggestion, telling that he came from YAR and it is difficult for him to come back in case of deterioration.

Laminectomy of L4 and partial of L5 was performed, during the first stage of the skeletonization the soft tissues came with great force, confirming that there was great pressure. Bilateral flavotomy of L4-5 was achieved and foraminotomy of both L5 roots was done. There were signs of chronic inflammatory changes involving the ligamentum flavum and the epidural fat. Inspection of the posterior wall of the L4-5 disc revealed no extrusion. Check for instability denied any presence for overmobility. 

Routine closure of the wound and smooth postoperative recovery with improvement of the power of both feet and disappearance of sciatica.

The presence of segmental chronic hypertrophic ligamentitis of the ligamentum flavum with exacerbation of the inflammation, were the cause of the patient problem. It is rare to operate such case. The patient urged for surgery and he was with the right decision.

The lumbar canal stenosis is a progressive disease and even if surges of inflammation took place, surgery will stop the escalation of such events.