The patient came to the clinic 16-May-2009 complaining of LBP with right sciatica for 5 years with exacerbation of left sciatica the last 4 days and inability to walk more than 20 meters. She is using crutches for 2 days.

She underwent open heart surgery 10 years ago and has controlled diabetes mellitus.

MRI lumbar spine performed 9-May-2009 showing lumbar canal stenosis L4-5 and L3-4.

On examination: the patient is limping with scoliotic stance, SLRS was 45 degrees in the right and 30 degrees in the left side and weak dorsi and planterflexion left foot 3/5 and 4/5 right foot..

Decompressive laminectomy of L4,5 and partial of L3 was done. Foraminotomy both L5 roots was achieved with special attention to the left L5 root. It was severely compressed by the hypertrophied facet and there was a tough vein encircling the root, which was coagulated and bisected to eliminate any compressing elements even if it is a vascular component. The root became free of any compression over 12 mm of distance from the axilla. Inspection of the L4-5 disc was negative for any pain generating structure, for what it was left untouched. The epidural fat was missing at the compressed sited. Routine closure of the wound.

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

Lumbar canal stenosis is a progressive disease and surgery is mandatory when it is progressing.

The cause of pain could be not from the extruded disc , but it could be from and extruded ganglion from the facet  or vascular compression, as in neuralgia. All these factors must be taken into consideration and eliminated accordingly.