The patient was operated by me 07-January-2010 for PLD L4-5 with secondary segmental stenosis. The patient then came 03-November-2010 complaining of bilateral sciatica with right upper limb pain and numbness of the right hand for what later right carpal tunnel release was done. The patient could walk more than 1 Km and had no motor deficit. MRI lumbar spine done 06-November-2010 showing stenosis of L2-3 and L3-4 with slight stenosis of C5-6, C6-7. Gout was found and conservative treatment was advised.

The patient then came 22-November-2012 complaining of LBP for 4 months with bilateral sciatica with exacerbation the last month. She cannot walk more than 20 meters.

MRI of the lumbar spine done 22-November-2012 showing severe lumbar canal stenosis L2-3 and L3-4. Dorsal MRI was normal.

On examination: the patient is limping as dragging the left leg with exaggerated scoliotic stance. SLRS 60 degrees both sides with pain. There is weak dorsiflexion both feet 4/5. The quadriceps femoris are also weak 4/5.

Decompressive laminectomy of L2,3 with foraminotomy L3, L4 roots both sides. Dissection was done down until the scar was freely movable. Bilateral flavotomy L1-2. The dura was lacking the epidural fat due to severe compression. Check of the roots for any compression both sides. The bulge disc of L3-4 was contained and it was decided not to violate it.

Routine closure of the wounds. Smooth postoperative recovery. The power of both feet became normal.

The patient has severe lumbar canal stenosis which progressing over the time and it is hard to predict the escalation of the events until the stenosis becoming clinically proven to be corrected by surgery.

Bilateral flavotomy of L1-2 was done to prevent future escalation of the stenosis at this level.