The patient came to the clinic 02-March-2002 complaining of  LBP for 12 years with both legs pain. 3 days ago got pain right knee. Using crutch for 4 years.

On examination: The patient is unable to walk without aid and unable to be evaluated for Romberg position, stance and limping. SLRS was 90 degrees without pain. There is weak dorsi, planterflexion both feet with abduction both knees.

The patient was sent for investigation and MRI lumbar spine showed severe stenosis L3-4, L4-5 with mild spondylolisthesis L4-5.

Skeletonization of L3-4-5 with preservation of the interspinous ligaments. Wide fenestration and foraminotomy both L4 and L5 roots both sides. Check for overmobility was negative. Routine closure of the wound.

Smooth postoperative recovery. The power of the feet improved slightly. She was sent to the ward.

The patient came to the clinic 23-March-2002 with clean wound, numb left L5 territory with with still weak left foot 4/5.  The right knee pain disappeared and abduction of the knees improved.

The patient after slight improvement then came 16-January-2005 telling that the last 10 days got pain both knees , ataxia, no sensory, nor motor deficit. OA both knees with aseptic arthritis right knee  with weak grip, extension right hand and right biceps. The patient was sent for investigations including the cervical spine, but she disappeared.

The wide fenestration at four regions with foraminotomy with preservation of the bony elements so as to avoid iatrogenic escalation of overmobility is difficult task, but achievable as in this case.

After 20 years; I would prefer transpedicular fixation of L3-4-5 level with decompressive laminectomy with foraminotomy all concerned roots . ( 09-April-2021).