History:
Mrs. Lilabai Sudake, a 56-year-old woman, came with complaints of chronic low back pain and bilateral leg pain, more severe on the left side, which had been ongoing for over 20 years. In the last 4 months, her symptoms had worsened significantly. She experienced:
Tingling and numbness in both legs (left more than right)
Difficulty getting up from a seated position
Neurogenic claudication, with a walking capacity of only 3–4 minutes and standing limited to 2 minutes
Disturbed sleep due to constant pain
Her gait was limping, with a visible tilt to the right side, and she was unable to walk on her heels or toes because of the pain.
On neurological examination:
Muscle strength was slightly reduced in the extensor hallucis longus (EHL) on both sides, with a power of 4/5.
Reflexes were decreased, showing diminished ankle reflexes and a hypoactive knee jerk on the left side.
A sensory deficit was observed in the left L5 dermatome, indicating nerve involvement.
The slump test was positive on the left side, suggesting nerve root irritation or compression.
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X-ray:
Revealed Grade I spondylolisthesis of L4 over L5, indicating slight forward slippage of the L4 vertebra.
MRI :
Multilevel degenerative disc disease, showing age-related wear and tear across multiple spinal levels.
Annular tear at L5-S1, suggesting a disc injury that may cause back pain or nerve irritation.
Severe spinal canal stenosis at L4-L5, with moderate to severe compression of the traversing and exiting nerve roots from L3 to S1, which explains the patient’s neurological symptoms and leg pain.
MRI:
Surgical Procedure:
On 25th October 2023, Mrs. Sudake underwent a successful posterior spinal fusion from L4 to S1 under general anesthesia. The surgical procedure included:
Decompression of the spinal canal to relieve pressure on the compressed nerves
Instrumentation and spinal fusion using Kentro implants for structural support
Stabilization of the affected vertebrae to restore spinal alignment and reduce pain
Post-Operative Recovery:
The patient was mobilized with full weight-bearing ambulation before discharge.
There were no post-operative complications, such as infection or fever.
The patient was discharged in a stable condition on 28th October 2023.
Two-Year Follow-Up (October 2025):
At her 2-year post-surgery follow-up, Mrs. Sudake reported a significant improvement in her quality of life:
Complete relief from lower back and leg pain
Walking and standing without any limitations
No tingling, numbness, or neurogenic claudication symptoms
Resumed daily activities comfortably, including household chores and errands
No recurrence of symptoms and no further medical or surgical interventions needed
Expert Opinion:
This case demonstrates the remarkable success of timely surgical treatment in managing chronic lumbar canal stenosis. With accurate diagnosis, detailed imaging, and the use of advanced spinal surgical techniques, even patients with long-standing symptoms—like Mrs. Sudake—can experience complete recovery and return to an active, pain-free lifestyle.