The patient came to the clinic 20-May-2010 complaining of LBP with inability to bend the spine for 2 months. The last 3 weeks he became unable to walk with bilateral sciatica more the left.

On examination: SLRS was 75 degrees in the right and 50 degrees in the left with pain. The patient cannot stand for evaluation for Romberg or scoliotic stance evaluation. He has severe profound weak planterflexion both feet 3/5 and dorsiflexion right foot 3/5 and left foot 2/5. He had hypalgesia right L4 root territory.

MRI lumbar spine performed 23-May-2010 showing severe stenosis L3-4 with bulging L3-4.

Decompressive laminectomy L3 and partial of L4 was performed using image-intensifier, so as to minimize the area of dissection. All the compressive elements were eliminated and inspection of the annulus fibrosis both sides revealed that it is better not to violate the disc space of L3-4. Check for instability was negative. Foraminotomy was done with limited extension due to abnormal very medial position of the isthmi.

Routine closure of the wound.

Smooth postoperative recovery with improvement of the power of both feet.

The stenosis was so severe that, almost drop both feet took place. The bulging disc was part of his problem, but not essential. The major problem was from the hypertrophied facet joints.

Lumbar canal stenosis is usually a progressive disease and the sooner surgery is performed the better the outcome.

Discectomy can only be decided after inspection of the annulus fibrosis both sides. If it is glistening and there is no extrusion, it is better not to violated the disc space.