The patient came to the clinic 22-March-2010 complaining of LBP for 7 years with left sciatica  for one month with numbness of the left L5 and S1 territories. The patient is a known hypertensive and has gout.

On examination: the patient was limping with exaggerated scoliotic stance. SLRS was 90 degrees both sides. There was weak dorsiflexion both feet 4/5 right and 3/5 left, and planterflexion left foot 3/5. There was severe O.A. both knees without pain.

MRI done 23-March-2010 showing severe lumbar canal stenosis L3-4 and L4-5 with extruded disc L4-5 more in the left.

Decompressive laminectomy of L4 and partial of  L5 with  foraminotomy of L5 roots both sides. Flavotomy of L3-4 was performed. There is no epidural fat and no overmobility of the segments. Inspection of the annulus fibrosis revealed the extrusion in the left side, which was removed and the disc space of L4-5 was removed from the left side and bilateral cleaning of the L4-5 disc space was achieved.

Routine closure of the wound and smooth postoperative recovery.

The power of both feet dramatically improved.

Lumbar canal stenosis is a progressive disease and early surgical intervention in case of progression avoid the patient unnecessary possible complication. Extruded disc make the picture more fulminant.

Total decompression must be performed including the canal and the roots. and removal of the extrusion must be performed, because in case of leaving it . it will extruded more because there is plenty of space to extrude further after the surgery.

The estimated recurrence rate in this case is ranking around 7%, because the disc space height still not shallow.