PMC9187487_01
Radiographic images before and after the first surgery. (a) Computed tomography (CT) myelogram before the first surgery showing central canal stenosis at L3/L4. (b) Magnetic resonance (MR) image before the first surgery showing central canal stenosis and facet effusions at L3/4. (c) Dynamic X-ray images (neutral, extension, and flexion position) before the first surgery showing mild L3 spondylolisthesis with a 4-mm slip change. (d) CT image 5 days after the first surgery showing unilateral partial laminectomy at L3/L4.
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He underwent microscopic, unilateral, partial hemilaminectomy with bilateral flavectomy 12 years ago ("first surgery"; Figure 1). Before the first surgery, mild L3 spondylolisthesis with a 4-mm slip change was observed on dynamic X-ray examination (Figure 1(c)), and a facet effusion was detected by magnetic resonance imaging (Figure 1(b)).
Radiographic images before and after the second surgery. (a) Computed tomography (CT) myelogram before the second surgery showing restenosis due to marked bone overgrowth of the lamina and facet joints. (b) Magnetic resonance (MR) image before the second surgery showing lumbar canal stenosis at L3/L4. (c) Dynamic X-ray images (neutral, extension, and flexion position) before the second surgery showing no significant changes in lumbar alignment or spinal stability. (d) CT image 4 days after the second surgery showing the results of the bilateral laminectomy at L3/L4.
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Bone over-regrowth of the laminar arch and facet joints was detected at the decompression site, by computed tomography (CT), which induced lumbar canal restenosis at the L3/L4 level (Figure 2(a)). Dynamic lumbar X-ray examination did not show overt progression of spondylolisthesis at the L3/4 level (Figure 2(c)). Prostaglandin E1 analog was ineffective in treating his symptoms; subsequently, a laminectomy of L3 and L4 was performed ("second surgery"; Figure 2(d)).
Computed tomography (CT) images after the second decompression surgery. (a) CT images 6 months after the second surgery. (b) CT images 1 year after the second surgery. (c) CT images 2 years after the second surgery showing bone regrowth mainly around the facet joints. (d) CT images 4.3 years after the second surgery showing the marked bone regrowth over the lamina.
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CT and CT myelogram revealed canal stenosis due to marked bone overgrowth and disc herniation of L3/L4 (Figures 3 and 4(a)).
Radiographic images before and after the third surgery. (a) Computed tomography (CT) myelogram before the third surgery showing re-restenosis due to marked bone overgrowth of the lamina and facet joints. (b) Magnetic resonance (MR) image before the third surgery showing central canal restenosis due to marked bone overgrowth and disc herniation of L3/L4. (c) Dynamic X-ray images (neutral, extension, and flexion position) before the third surgery showing no significant changes in lumbar alignment or spinal stability. (d) CT image 1 day after the third surgery showing the results of the bilateral laminectomy at L3/L4.
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CT and CT myelogram revealed canal stenosis due to marked bone overgrowth and disc herniation of L3/L4 (Figures 3 and 4(a)). No significant changes in lumbar alignment or spinal stability were observed (Figure 4(c)). A laminectomy of L3 and L4 was performed ("third surgery"; Figure 4(d)), and the patient's symptoms improved again following the surgery, and the visual analog scale score for lower limb and buttock pain was improved from 8/10 cm to 1/10 cm 6 months after the third surgery.