The patient was operated by me twice for cervical canal stenosis the second operation was done 23-February-2013 by posterior decompression. The patient showed considerable improvement over the months, then came 18-June-2014 complaining of LBP for 2 months without sciatica with cramps both lower limbs. He cannot walk more than 30 meters due to intermittent claudication.

On examination; the patient walking bended. SLRS was 80 degrees both sides. Weak dorsi and planterflexion both feet -4/5. There is hypalgesia both L5,S1 territories. The left hand extension and the left triceps were -4/5, which was the same as the last visit in 06-March-2013.

The patient was sent for investigations and the MRI lumbar spine performed 01-July-2014 showing severe lumbar canal stenosis L2-3 with mild stenosis at L1-2.

Using C-arm, the L2-3 level was identified. During skeletonization, it was evident that the upper half of the L4 spinous process suffered fracture, but the whole area is stable. Decompressive partial laminectomy of the lower 2/3 of L3 and upper 2/3 of L4 until the epidural fat was seen in both levels. Foraminotomy of both L4 roots. During inspection of the disc of L3-4, which was hard and smooth, massive bleeding from the epidural veins took place, because the patient was obese. It was stopped by muscles applied to the left upper corner. Hemostasis. Routine closure of the wound.

Smooth postoperative recovery. The power of both feet became better.

The LCS is a progressive disease and the sooner the surgical decompression the best the postoperative recovery.

The patient is a complicated case and he underwent 2 surgeries for cervical stenosis and has malacia of the spinal cord. It is hard to predict the level of the postoperative recovery after this last surgery. Time will tell.