Lumbar canal stenosis when progressive, it must be treated by surgical decompression. The sooner the decompression the better the outcome.

The patient admitted to the clinic 01-March-2003 complaining of LBP for 2 months with bilateral sciatica more to the right. Can walk 1 Km without intermittent claudication. Diabetic for 33 years and hypertensive for 15 years.

On examination: the patient is in agonizing pain, limping with exaggerated scoliotic stance with SLRS 70 degrees right side with pain and 80 degrees left side with pain. He has weak dorsi and planterflexion both feet 4/5. There is hypalgesia L5.S1 roots above the ankle level both feet.

The patient was sent for investigation and MRI lumbar spine done 08-March-2003 showing severe segmental stenosis L4-5.

Decompressive laminectomy L4-5 with foraminotomy both L5 roots. Inspection of the disc space was uneventful, for what it was decided not to violate it. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Routine closure of the wound

Smooth postoperative recovery. He was sent to the ward.

The patient came to the clinic 26-May-2003 with clean wound and full power and lowering of hypalgesia to the toes.

The patient then came 30-March-2004 telling that he was in good condition until the last 2 months got LBP  with SLRS 70 degrees both sides with minimal pain and weak dorsiflexion left foot 4/5. He was sent for investigation and MRI lumbar spine done 01-April-2004 showing collapse of L4-5 with bulge of L4-5. He was treated conservatively.