The patient came to the clinic 25-February-2007 complaining of LBP for 11 years with bilateral sciatica and inability to walk more than 50 meters with signs of bilateral carpal tunnel syndrome for 2 months more the left hand.

MRI lumbar spine performed 24-October-2004 showing lumbar canal stenosis L4-5.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 45 degrees in the right and 50 degrees with pain in both sides. Almost drop right foot with weak dorsiflexion left foot 4/5 and right foot planterflexion 4/5. Sensory los of the L5 and S1 territories both sides.

MRI lumbar spine with MR Myelography was requested and done 26-February-2007 showing more severe LCS L4-5 with mild stable spondylolisthesis at that level.

Decompressive laminectomy of L4 and 5 with foraminotomy for L5 roots both sides was achieved and all the compressive elements were eliminated. Inspection of the L4-5 disc space was negative for presence of any extrusion from the disc, for what it was decided not to violate it.

Routine closure of the wound and smooth postoperative recovery with improvement of the motor power both feet.

 

The relatively young age of the patient to such pathology with absence of osteoporosis, confirming that the cause is an inflammatory with hypertrophic changes of the ligamentum of flavum and the surrounding ligamentous structures around the facet joints. The presence of anatomical variation of segmental stenosis trigger the clinical manifestations.