The patient came to the clinic 08-December-2014 complaining of left sciatica for 2 years  and right hip pain for 10 days. MRI lumbar spine done 30-November-2014 bad quality showing stenosis of L3-4. The patient was operated by me 1994 for PLD L4-5 and 1996 for recurrence of the same disc.

On examination, the patient using crutches  for 2 years and cannot now walk more than 50 meters. He is limping with exaggerated scoliotic stance. SLRS was 70 degrees both sides with pain in the left. There is hypalgesia below the left L1 root .Complete drop left foot with weak dorsiflexion right foot 4/5.

The patient was sent for MRI of the dorsal and lumbar spine. MRI lumbar done the same day showing lumbar canal stenosis L2-3. 3-4 with ganglion of the left L5-S1 facet compressing the left S1 root. Dorsal spine was normal. Dynamic studies showed bamboo spine with fusion all the lumbar vertebral bodies.

Through inferior incision left S1 foraminotomy was done and all the compressive elements were eliminated. The disc of L5-S1 is hard. Laminectomy L3 and lower half of L2 and the remnant of L4 were removed through another incision. The dura due to severe compression at L3-4 was missing in several areas. Some of the areas were stitched using 6 zero nylon and some were stitched with muscle and aided with surgicele. Water-tight closure of the wounds.

Smooth postoperative recovery. The power of the right foot became normal, but the drop left foot still the same.

The severity of stenosis was that the dura was eaten in several places. Several types of repair were applied to avoid postoperative CSF leak.