The patient came to the clinic 25-April-2004 complaining of LBP with bilateral sciatica for 10 years, more to the left. Cannot walk more than 5 meters with intermittent claudication. She has rheumatoid manifestations. MRI lumbar spine done 20-April-2004 showing severe lumbar canal stenosis L2-3, 3-4 and L4-5.

On examination, the patient in pain, limping with exaggerated scoliotic stance, walking bended anterior with weak dorsiflexion both feet 4/5, more the left and weak planterflexion right foot. SLRS was 60 degrees with pain both sides. There is hypalgesia both legs 20 cm above the ankle joints.

Laminectomy L3,4, upper half of L5 and lower half of L2. Foraminotomy of L3,4,5 roots both sides. Inspection of the disci was uneventful. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. 2 long pieces of fat in pedicle were harvested from the subcutaneous layer and covered the exposed parts of the dura and roots to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The power of the feet normalized.

The patient came to the clinic 03-July-2004 with clean wound and no motor, nor sensory deficit. SLRS was 80 degrees both sides without pain.

The patient came several times over the years for her rheumatoid manifestations then came 21-October-2009 with MRI lumbar spine performed the same day showing stenosis of L2-3 and L3-4 with small extruded disc both levels with deformity of left L3-4 facet rupture ACL both knees . The patient was given medications and sent for ortho consultation and in case of not improving to consider surgery for spine and she disappeared.

Progressive lumbar canal stenosis must be corrected surgically. The sooner the intervention, the better the outcome.

Rheumatoid manifestations can over the years cause secondary stenosis at the same place and other places of the vertebral column.