The patient came to the clinic 20-August-2007 complaining of LBP and bilateral sciatica for 2 months more to the right. He came with crutches.

On examination SLRS was 10 degrees in the right side with weak dorsi and planterflexion all toes right foot and scoliotic stance.

The patient came to the clinic 21-December-2006 complaining of LBP for 20 years with exacerbation last year and numbness left foot. MRI lumbar spine was performed 23-July-2007 showing small PLD L1-2 right side and huge PLD L4-5 with huge central extrusion more to the left with secondary segmental canal stenosis.

On examination: there is weak dorsiflexion right foot 4/5 and left foot 3/5 and planterflexion left foot 4/5. There is hypalgesia left L5 and S1 territories. SLRS was 30 degrees in the left with pain.

Bilateral L4-5 flavotomy with foraminotomy both L5 roots was performed and the extruded disc was attacked first from the left. After relaxing the right L5 root, the disc was attacked from the right and bilateral meticulous cleaning of the extrusion and the disc space was performed. The epidural fat was preserved during surgery to prevent postoperative fibrosis.

Routine closure and smooth postoperative recovery and normalization of the power of the both feet.

The patient showed surgical emphysema at the neck level and the lower half of the face. Chest X-ray done ruling out the presence of pneumothorax.

After 5-6 hours the emphysema resolved completely.

The patient has long history of LBP with the disc still having extrusion of huge size, which did not resolve over the years. Drilling of the medial aspects of the facet joints before dealing with the neural structures, minimize the surgical injury, for what immediate postoperative recovery of the power of both feet was noted.

Anesthesia induced surgical emphysema is a rare complication and in mild cases it resolve within several hours, as in this case. It seem that barotrauma was the cause in this case