The patient came to the clinic 18 months ago complaining of signs of severe lumbar canal stenosis and he was advised to undergo surgery, but he escaped. The patient then came 08-November-2011 complaining of bilateral sciatica and intermittent claudication for 2 years and inability to walk for more than 50 meters. He is using crutches for 18 months. The patient is a known diabetic for 20 years and he is insulin dependent for 2 years. He is using Omnic for 18 months for difficult micturition, despite the fact that the prostate is normal in size.

MRI lumbar spine performed 08-November-2011 showing severe lumbar canal stenosis L3-4 and L4-5.

On examination: the patient is limping with exaggerated scoliotic stance. There is weak dorsi and planterflexion both feet 3/5. There is hypalgesia both legs below the knee level.

Decompressive laminectomy of L4 and partial of L3 and L5. Bilateral flavotomy with bilateral L4 root foraminotomy. The spinous process is mobile. It was resected to prevent postoperative pain, when palpating the spine. Inspection of L4-5 isthmolysis was negative. Revision of the MRI data were also negative. There is no evidence of L4-5 nor L5-S1 spondylolisthesis. The epidural fat at the L3-4 was missing.

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

The patient has severe lumbar canal stenosis and he condition continued to deteriorate during his escape.

LCS is a progressive disease and the sooner the decompression, the better the postoperative outcome.

After surgery, the son of the patient told us that the patient felt down 4 days ago. This could explain the presence of the mobile L5 spinous process, but there was no associated hematoma in this area. 3/4 of the L5 lamina was left in place and the ligamentous structures were respected and preserved to avoid iatrogenic overmobility of L4-5 segment.