The patient came to the clinic 13-April-2006 complaining of intermittent claudication for 10 years. MRI lumbar spine done 06-December-2005 showed lumbar canal stenosis L3-4 and L4-5. He could walk 30 meters after what numbness both feet and bilateral sciatica took place. He had scoliotic stance, SLRS was 60 degrees in the right and 30 degrees in the left with pain. He had hypalgesia left L5 root territory with weak dorsi and planterflexion both feet 4/5. He had dripping of urine for 1 year. He was advised to undergo surgery, but he escaped.

The patient then came 02-March-2009 with further deterioration with new MRI lumbar done 20-October-2008 showing the same stenosis. He claimed that there was no micturition problems, but he has hypalgesia at the right knee and a little below the left knee. He had flail right foot with severe weak left foot dorsi and planterflexion 2/5. The patient is using crutches for 1 year. The patient performed MRI lumbar spine 03-March-2009 and given admission for surgery, but he another time escaped.

The patient then came 06-November-2013 telling that he got agonizing LBP with bilateral sciatica more the left the last 4 days with inability to void, for what Foley's catheter was applied and inability to defecate. The patient is in wheelchair. He has trigger III IV fingers both hands. He has analgesia below L3 level with fulminant cauda equina syndrome. Weak adductors 3/5 and flail both feet and abduction of the limbs at the knees 0/5.

MRI cervical, dorsal and lumbar spine done 06-November-2013 showing cervical canal stenosis at C4-5, C5-6, dorsal showed huge extruded disc D12-L1 with severe compression of the spinal cord more to the right. The old lumbar canal stenosis at L3-4 and L4-5 still the same with spondylolisthesis L3-4.

Laminectomy D12 and upper half of L1 with the guidance of the C-arm.  Foraminotomy of the right L1 root. The extruded disc of D12-L1 was removed from the right . There was no epidural fat and the up and downward migrating pieces were removed.

Smooth postoperative recovery. The power of both feet became better.

The patient has huge recent extruded disc D12-L1 causing the fulminant cauda equina syndrome. This takes precedence for surgery.

Since lumbar canal stenosis is near the filed, decompression and fixation can be done at the same surgery. The patient for paramedical reasons was willing to be operated only for extruded disc D12-L1.