The patient was operated by me 04-July-2019 for removal of the lower screws penetrating the S1 roots. The patient then was operated elsewhere with removal all of the screws. The patient then came to the clinic 17-July-2021 with new MRI done 05-April-2021 bad quality not informative. The patient then came 21-August-2021 complaining of LBP with constipation and difficult micturition.

On examination, the patient is walking with help of 2 persons. There is weak both iliopsoas muscles 4/5 and both quadriceps 4/5, adduction and abduction of the knees 3/5 with flail both feet 0/5 and analgesia below both knees.

The patient was sent for investigations and cardio consultation. MRI whole spine done 21-August-2021 showed severe stenosis D10-11 and D11-12. Urine for CXS showed streptococcus spp, for what Zinnat was started. It was agreed with the family that surgery will help stop the process of further deterioration.

New incision over the first long one and skeletonization of D10, 11 and 12. Decompressive laminectomy D10,11,12. Foraminotomy D11. 12, L1 both sides. Inspection of the disc of D11-12 both sides. The ligamentum flavum was adherent to the dura in maximum compression, for what sharp dissection was done to avoid tear of the dura. Using MultiGen was impossible due to severe adherence of the ligamentum flavum to several areas. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. A piece of muscle tissue was used to cover the root territory to minimize the postoperative scar formation and prevent postoperative CSF leak. Routine closure of the wound. Smooth postoperative recovery. The neurologic status the same. She was sent to the ward.

Too early now.

The stenosis was so severe that the ligamentum flavum was adherent to the dura in several places.