CASE REPORT
Minimally Invasive Endoscopic Spine Surgery
Minimally Invasive Endoscopic Spine Surgery
Two-level lumbar decompression for severe spinal canal stenosis at L3–L4 and L4–L5
Level of die
Lumbar levels treated (L3–L4, L4–L5)
Symptom Onset
Compressed nerve sites decompressed
Pain-free
Post-operative outcome at follow-up
MIESS
Minimally invasive endoscopic spine surgery performed
Clinical history
Mr. Shantibhai Joshi, a resident of Diodar, Gujarat, presented with a long-standing history of severe lower back pain accompanied by pain radiating into both legs and difficulty climbing stairs. On detailed clinical evaluation, he was diagnosed with lumbar spinal canal stenosis, a narrowing of the spinal canal causing severe compression of the nerve roots at the L3–L4 and L4–L5 levels of the lumbar spine. Given the severity and bilateral nature of his symptoms, surgical decompression was recommended after conservative measures were considered insufficient to relieve his condition.
Imaging and clinical assessment confirmed severe nerve compression at two adjacent lumbar levels, correlating with the patient's bilateral leg pain and difficulty climbing stairs.
Dr. Rohit Thaker performed an advanced minimally invasive endoscopic spine surgery at Spine 360, accessing the affected levels through a small incision using endoscopic visualization to minimize tissue disruption.
The compressed nerve roots at both the L3–L4 and L4–L5 levels were carefully decompressed during the procedure, relieving the pressure responsible for the patient's pain and mobility difficulty.
The minimally invasive nature of the procedure allowed for a smooth post-operative course, with the patient progressing quickly toward pain-free movement and return to daily activity.
Outcome
Following surgery, Mr. Shantibhai is completely free from his pain — he now walks comfortably, performs his daily activities without difficulty, and has returned to living a normal, active life.
Cause and clinical significance
Lumbar spinal canal stenosis is most commonly caused by age-related degenerative changes, including thickening of the ligamentum flavum, facet joint hypertrophy, and disc bulging, which progressively narrow the space available for the nerve roots within the spinal canal. When this narrowing occurs at multiple levels, as in this case, patients often present with bilateral radicular leg pain, lower back pain, and neurogenic claudication — difficulty walking or climbing stairs that improves with rest or forward flexion. Left untreated, significant nerve compression can lead to progressive functional limitation. Minimally invasive endoscopic decompression addresses the underlying compression directly while limiting disruption to surrounding muscle and soft tissue, supporting faster recovery compared with traditional open surgery.