The patient is a Libyan citizen came to the clinic 08-February-2012 complaining of difficult walking after surgical intervention performed in Libya 15-January-2009. Fixation of L4-5 and S1 was performed at that time. The patient continued to deteriorate and MRI cervical spine performed 06-October-2011 showing small disc C6-7 , but dorsal MRI showing severe stenosis of the canal at D4-5, D5-6, D10-11 and D11-12.

On examination, the patient cannot walk with severe atrophy of both lower limbs. There is profound weak both lower limbs 3/5 of all muscles. Babinski sign was positive both sides, but there was no clonus. No sensory deficit.

The patient was sent for further evaluation. MRI of the brain performed 20-February-2012 showing scattered lacunar infarctions both cerebral hemispheres. MRI dorsal spine performed 13-February-2012 showing severe stenosis at the above mentioned levels with malacia of the spinal cord at these levels. The stenotic elements were due to ligamentum flavum hypertrophy.

In prone position, skeletonization of D1 down to D5 was performed. The patient has massive bleeding tendency. She lost in this stage 750 ml blood. Considering her age, it was decided to perform the upper part of the surgery and laminectomy of D2-5 with partial of D1 and D6. All the compressive elements were eliminated. There was no epidural fat at the area of exposure.

Routine closure of the wound. Smooth postoperative recovery with improvement of the power of both legs.

It was planned to perform the 2 surgeries, but due to massive bleeding tendency, it was decided to postpone the second surgery for several days.