The patient came to the clinic 08-August-2002 complaining of LBP with bilateral sciatica with weak dorsi and planterflexion both feet more pronounced in the right. She underwent total knee replacement without improvement. The patient has diabetes mellitus and hypertension.

On examination: The patient is walking with wheelchair and unable to be evaluated for Romberg position, nor stance. There is LBP with bilateral sciatica with SLRS 45 degrees both sides with pain, more in the right. Weak dorsi and planterflexion both feet more pronounced at the right side.

The patient was sent for investigations and MRI done showing severe stenosis L3-4, 4-5, L5-S1 with possible overmobility of L2-3.

Skeletonization of L2-3-4-5 and upper sacrum. Check for overmobility of L2-3 was negative. Decompressive laminectomy of L4,5, upper sacrum and lower third of L3 with foraminotomy both L3,4,5 and S1 both sides. There were 2 separate dural defects, which were repaired by nylon stitching. Inspection of the disci revealed extruded disc L4-5 right side, which was removed accordingly with right intradiscal cleaning L4-5 disc space. Despite the fact, that there is no overmobility, the posterior walls of L2 and L3 and chips of bone harvested from the patient were applied posterior to the laminae, incase of possible escalation of overmobility. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Routine closure of the wound.

Smooth postoperative recovery. She was sent to the ward.

The patient came to the clinic 23-August-2002 with clean wound and dramatic improvement in her neurologic deficits.

There is still a possibility for disc recurrence around 7%, because the disc space is not shallow.