Clinical Course
This 78 year old male had a 4 year history of the gradual onset of right leg pain and left leg numbness. His leg symptoms were worse with walking and standing and were relieved with sitting. He rated his pain as 8 on a scale of 10 with complaints of 80% leg pain and 20% low back pain. He had received epidural steroid injections without relief. He had co-morbidity factors complicating his treatment: heart disease with Coumadin (a blood thinning medicine). After medical consultation, the patient elected to have surgery because he was unable to walk a single block without leg pain.

Diagnostic Tests
His MRI scan was conclusive demonstrating multi-level lumbar spinal stenosis.

Decision
This patient could not walk or stand due to severe leg pain. Even though he had heart disease and would have to be taken off of blood thinning medicine for surgery, he elected to have surgery due to his significant disability.

Surgical Treatment
A traditional lumbar laminectomy was performed which is to unroof the spinal canal to provide room for the spinal nerves. He did well post operatively and was able to walk without leg pain.

Surgeon's Comment
Although, there are different technical options for lumbar decompression for spinal stenosis, the speed of surgery in the medically compromised patient is an essential ingredient to success. Alternative operations such as interlaminar laminotomies or microsurgcial decompressions are level by level usually slower than laminectomy. In addition, a stiff, immobile spine has inherent stability for decompression.