The patient came to the clinic 10-January-2007 complaining of LBP for 3 years with right sciatica. He claimed deterioration the last 3 months with inability to walk more than 20 meters with intermittent claudication. MRI lumbar spine performed 04-February-2002 showed LCS L4-5.

On examination: SLRS was 20 degrees in the right with weak dorsi and planterflexion both feet. There is diabetic neuropathy with diminished sensation of both feet above the ankle.

MRI performed 13-January-2007 showed severe stenosis L4-5 and L5-S1 with I-degree spondylolisthesis L5-S1 with synovitis of the L4-5 and L5-S1 facets both sides.

Laminectomy of L5 and partial of L4 and upper edge of S1 was performed. Foraminotomy of L5, S1 roots both sides was achieved. It was noticeable, that the left L4-5 foramen was very narrow, that special attention was needed for that area.  A very small amount of synovial fluid came out of the facet joints. confirming the presence of the above-mentioned synovitis. The dura was very transparent, that the running roots were seen through it.

Routine closure with smooth postoperative recovery with immediate postoperative normalization of the power of the feet.

Lumbar canal stenosis is a progressive disease and when the clinical manifestations take place surgery is the only solution, to stop the escalation of the pathologic process.

Inflammatory process, such as synovitis and hypertrophy of the ligamentum flavum increase the deteriorating factors in lumbar canal stenosis.

Most of the cases with LCS have lateral recess syndrome, and foraminotomy is a must in resolving the problem. Checking the foramina is mandatory in such surgery and adapted instrumentation must be available with the surgeon to be sure that no compression is left behind.