The patient came to the clinic 03-August-2010 complaining of LBP for 10 years with bilateral sciatica  and numbness both feet. He could walk only 50 meters and the condition is deteriorating. The patient is a known diabetic under treatment for 2 years.

MRI lumbar spine performed 20-July-2010 showing stenosis of L3-4 and L4-5.

On examination: the patient has moderate scoliotic stance. There is weak dorsi and planterflexion both feet -4/5. SLRS was 90 degrees in both sides.

The patient then came 18-September-2011 claiming that his condition became worse and there are signs of cauda equina syndrome with numbness of the perianal region and difficult micturition.

MRI lumbar spine was repeated 25-September-2011 the same data as the previous MRI and he was advised to undergo surgery, which he is trying to avoid.

Decompressive laminectomy L4 and partial of L3 and L5 was done. There was no epidural fat at these levels due to severe compression. Foraminotomy of L4 and L5 roots was achieved from both sides. The L4 roots were severely compressed and adherent to the surrounding tissues. Check for instability was performed at all stages of the surgery. It was negative. Inspection of the L3-4 was done from both sides. It was concluded, that it is better not to violate the intradiscal space.

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

Lumbar canal stenosis is a progressive disease, and the sooner the surgical interference, the better the outcome.

Recovery of the motor fibers take place immediately after surgery, but the sensory fibers take long time to recover.