The patient was operated by me 08-December-2003 for severe cervical canal stenosis C3-4, 4-5 and 5-6. She was then operated by me 13-December-2005 for lumbar canal stenosis L3-4 and L4-5.

The patient then came 14-September-2010, complaining of LBP with left sciatica for 2 years and inability to stand for more than 5 minutes or walk more than 30 meters.

On examination: The patient  walking bended  with SLRS 80 degrees in the left with pain. There is weak dorsiflexion right foot -4/5 and 3/5 left foot with analgesia below the both knees and hypalgesia right hand..

MRI lumbar spine performed 29-September-2010 showing severe lumbar canal stenosis at L1-2, L2-3  with extruded old disc L2-3 left side.  The patient was seen by cardiologist and cath done, which showed stenosis 70% of the left anterior descending artery.

Decompressive laminectomy of L1,2 with removal of the remnants of L3 and foraminotomy of left L3 root was achieved. There was no epidural fat and the dura was transparent, that the roots could be seen through it. The left L3 root was adherent to the surrounding structures. It was dissected off to remove the extruded disc of L2-3 from the left lateral to the axilla. After removal of the extrusion and cleaning of the disc space, CSF leak took place from a tiny dural defect lateral to the axilla. Nylon 6 zero 2 stitches were used and aided with 2 layers of muscle were applied to get secure closure of the defect to prevent postoperative CSF leak. Valsalva maneuver and putting the head above the operative field level confirmed no CSF leak.

Routine closure of the wound. Smooth postoperative recovery and improvement of the power of both feet.

The patient has lumbar canal stenosis with old extruded disc at L2-3 left side.

Decompression must include the ongoing stenosis at L1-2, so as to avoid further surgery in the near future.

Severe compression with adherent tissues can complicate the surgery with presence of dural defects, which were triggered after decompression.

This is a typical example about the progressive nature of canal stenosis with cervical component was the starting point and then the lower lumbar, then the upper lumbar spine.