Diagnosis

Severe lumbar spinal stenosis with radicular symptoms and objective neurologic deficit.

Procedure and level

Biportal endoscopic lumbar decompression. Clinically concordant lumbar stenosis level or levels.

Surgical levels and level count

Treated levels: Level count not reported
Decompression: Level count not reported
New fusion: None described

The source does not name the operated segment(s); the L5 dermatome is not a surgical level.

One level means one treated motion segment, such as L4-L5. Decompression and fusion can overlap; their counts are not added. Counts follow the source description and have not been re-audited against private charts.

Clinical presentation

The patient presented with persistent leg-dominant symptoms despite medication, physical therapy, and injection treatment. The clinical findings included left-sided sensory disturbance in an L5 dermatome distribution and motor weakness involving ankle dorsiflexion and great toe dorsiflexion.

Neurologic findings

Preoperative neurologic examination demonstrated left ankle dorsiflexion weakness, approximately grade 3, and left great toe dorsiflexion weakness, approximately grade 3. Sensory disturbance was documented in the left L5 dermatome. These findings were reviewed together with imaging before surgical planning.

Prior nonoperative treatment

The patient had persistent symptoms despite medication, physical therapy, and injection treatment. Surgical treatment was considered because symptoms and neurologic findings persisted and were concordant with the stenotic level.

Imaging and clinical concordance

Preoperative lumbar radiographs and MRI demonstrated severe lumbar spinal stenosis at the clinically concordant level or levels. The stenosis pattern included narrowing of the neural canal and compression of the symptomatic neural structures. Imaging findings were interpreted together with the patient's symptoms and neurologic examination rather than as an imaging finding alone.

Reasoning recorded for the procedure

Biportal endoscopic decompression was selected to address the symptomatic neural compression while preserving stabilizing structures as appropriate. The surgical target was defined by the relationship between the patient's radicular symptoms, neurologic deficit, and imaging-symptom concordance.

Operative considerations

Biportal endoscopic lumbar decompression was performed. The operative workflow focused on identifying the stenotic segment, creating a controlled working corridor, and decompressing the neural elements. A key technical step was careful separation of the adherent ligamentum flavum from the dura. The dissection plane between the hypertrophied or adherent ligamentum flavum and the dura was handled cautiously to reduce dural injury risk during decompression.

Postoperative course

Not reported in the available educational summary.

Postoperative imaging

Not reported in the available educational summary.

Educational point

This case illustrates that severe lumbar stenosis requires precise decompression planning and careful tissue-plane recognition. In severe stenosis, the ligamentum flavum may be hypertrophied or adherent to the dura. Safe decompression depends on identifying and maintaining the correct dissection plane between the ligamentum flavum and the dura, while avoiding unnecessary neural traction or blind instrument movement.

Published images and video

Media are identified by their public source. Journal figures open at the original source; operative video illustrates a technical example. Imaging and operative appearances do not measure pain relief, function, or durable fusion.

preoperative imaging

De-identified preoperative lumbar radiograph for severe lumbar spinal stenosis case. — De-identified preoperative radiograph used for lumbar level and alignment assessment.

De-identified preoperative sagittal lumbar MRI demonstrating severe stenosis. — De-identified preoperative sagittal MRI demonstrating severe lumbar stenosis.

De-identified preoperative axial lumbar MRI demonstrating severe stenosis. — De-identified preoperative axial MRI demonstrating neural canal narrowing at the clinically concordant level.

postoperative imaging

De-identified postoperative sagittal lumbar MRI after endoscopic decompression. — De-identified postoperative sagittal MRI after biportal endoscopic decompression.

De-identified postoperative axial lumbar MRI after endoscopic decompression. — De-identified postoperative axial MRI after decompression at the operated level.

Reported observations and missing data

Values below are limited to what the identified public source reports; source charts were not re-audited for this website update. Operative-time definitions and observation windows may differ. Do not compare these values across surgeons or procedures.

Operative time: 30 minutes.
Estimated blood loss: Not reported in the available educational summary.
Hospital stay: Not reported in the available educational summary.
Complications: Not reported in the available educational summary.
Follow-up interval: Not reported in the available educational summary.
Validated patient-reported outcome scores: Not reported in the available educational summary.

Evidence and further reading

These sources provide clinical context. They are separate from the source records for this case and do not verify its outcome.

External evidence · randomized trial
Decompression alone or with fusion for degenerative lumbar spondylolisthesis (Nordsten-DS): five year follow-up
Kgomotso EL et al. BMJ. 2024;386:e079771.
At five years, decompression alone was non-inferior to decompression with instrumented fusion in the trial population.
Applicability: Patient selection and exclusions matter. These findings do not establish that every slip needs fusion, nor compare UBE-TLIF with all alternative techniques.

Source, authorship, and limitations

Source material: Hanjin Jang, MD academic case collection. Case 01 in the previously published Case-Based Education collection by Hanjin Jang, MD. A separate case-level clinical review date and public consent record are not reported in the available source. This entry was organized on 2026-09-11; this date records a website update, not a new clinical review.

Selection is educational. No population denominator, consecutive recruitment process, comparative group, or complete follow-up dataset is supplied. A missing complication field does not mean that no complication occurred. Published observations do not predict another patient's outcome.

No new private patient files were added in this update. Corrections and future clinical additions follow the editorial policy.

Suggested citation: Hanjin Jang, MD academic case collection. Biportal Decompression for Severe Lumbar Stenosis. Casebank, Case 01. Updated 2026-09-11. https://www.hanjinjangspine1.com/casebank/lumbar-stenosis-biportal-decompression

Biportal Decompression for Severe Lumbar Stenosis