It is of the utmost importance that the level of the disc protrusion is identified before surgery. This may require MRI scanning and on-table fluoroscopy to prevent operating on the wrong level. A midline approach to the right or to the left of the spinous processes will depend upon the most prominent site of the disc bulge. In some instances removal of the lamina will increase the potential space and may relieve symptoms. Some surgeons perform a small fenestration (windowing) within the ligamentum flavum. This provides access to the canal. The meningeal sac and its contents are gently retracted, exposing the nerve root and the offending disc. The disc is dissected free, removing its effect on the nerve root and the canal.