The relatives of the patient came to the clinic 18-January-2012 telling that their mother complaining of LBP for more than 30 years with deterioration the last week with inability to walk. MRI lumbar spine performed 16-January-2012 showing severe lumbar canal stenosis L3-4 and L4-5. The patient is a known diabetic for 10 years.

The patient was seen in the emergency of Shmaisani hospital 22-January-2012. She is bedridden unable to walk with severe weak both feet 3/5 of dorsi and planterflexion. 

Decompressive complete laminectomy of L4 and partial of L3 and L5. Foraminotomy L4, L5 roots both sides. All compressive elements were eliminated. There is no epidural fat at these level. There was an extruded ligamentum flavum with ossified tissue compressing the dural sac  at L4-5 level reaching the midline, explaining the origin of the right sciatica. Inspection of the annulus fibrosis at L3-4, and L4-5 made the decision not to violate these structures.

Routine closure of the wounds. Smooth postoperative recovery with improvement of the power both feet.

The patient have lumbar canal stenosis, which is progressing over the time. In this case there is no alternative to surgical treatment.

The cause of sciatica to the right was due to facet soft tissue compression from the right L4-5 facet joint.