PMC9294320_01
Flexion and extension lateral lumbar X-ray radiograph demonstrating relative dynamic stability at all lumbar segments (A). Lumbar CT showing hyperplasia and cohesion of the facet joints, ossification of the ligamentum flavum and multilevel stenosis of the lateral recesses and central canals (B). Sagittal and axial T2-weighted lumbar MRI revealing serious central canal stenosis from L1-2 to L4-5, lumbar disc herniation and left lateral recess stenosis at L5-S1 (C).
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F1
Flexion and extension lateral lumbar radiographs showed relative dynamic stability at all lumbar segments (Figure 1A). Lumbar computed tomography (CT) showed multilevel degenerative stenosis and L4 spondylolisthesis (Figure 1B). Magnetic resonance imaging (MRI) revealed serious stenosis from L1-2 to L5-S1 and left lateral recess stenosis at L5-S1 (Figure 1C).
Bilateral L5 and S1 nerve roots and dural sacs after first-stage first stage UBE-ULBD (arrowheads indicate nerve roots, asterisks indicate dural sacs).
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F2
In the first stage procedure, the patient's radicular pain of lower limb was considered, double ULBD at L4-5 and L5-S1 from the left side was performed through first-stage UBE to decompress the bilateral L5 and S1 nerve roots and dural sacs (Figure 2).
Bilateral L4, L3 and L2 nerve roots and dural sacs after second-stage UBE-ULBD (arrowheads indicate nerve roots, asterisks indicate dural sacs) (A). Residual left lamina of L4 after L4-5 and L3-4 UBE-ULBD (B). The surgical incisions after the two-stage procedure and the counterparts of the surgical segments (black arrowheads indicate the first-stage operation, white arrowheads indicate the second-stage operation) (C).
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F3
The bilateral L3, L2, and L1 nerve roots and dural sacs were decompressed through the second-stage procedure (Figure 3).
The patient achieved favorable flexion and extension of the back with little pain (A). Regions of bone resection after the two-stage procedure (red circles) (B).
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F4
The patient was discharged home after her low back pain was relieved, and she was able to bend and stretch her back (Figure 4A). Postoperative lumbar radiographs showed the range of laminectomies and decompressed lumbar spinal canals (Figure 4B).
The lumbar X-ray radiograph of 1-year follow-up demonstrating all surgical segments remained stable (A). Lumbar CT of 1-year follow-up showing the bony structure changes of surgical segments (B). Sagittal and axial T2-weighted lumbar MRI revealing satisfactory decompression of lumbar canal from L1-2 to L5-S1 (C).
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F5
The 1-year follow-up's imagings showed satisfactory decompression of lumbar spinal canals, and the spondylolisthesis of L4 still not progressed (Figure 5).