Recently, Dr. Chuanli Zhou of the Eastern Region Spine Surgery Department successfully performed a percutaneous lateral approach laminectomy for multisegmental decompression in a 7-mm incision for a patient with two-segment lumbar spinal stenosis. The use of percutaneous lateral approach laminectomy under local anesthesia is becoming more and more mature in disc herniation, and the application of this technique in lumbar spinal stenosis is becoming a hot topic of research. The patient, a 56-year-old female, was admitted to the hospital with “lumbar pain and numbness and pain in both lower extremities for 3 months, aggravated for 1 week”, and had pain in the lumbosacral region and the back of the thighs bilaterally. He came to our lifelong medical expert, Director Chen Xiaoliang. After a detailed physical examination and a complete imaging examination, Chen diagnosed the patient with “lumbar spinal stenosis”, which was found in both L4/5 and L5S1 segments. He knew that traditional open surgery could completely solve the patient’s current situation, but to perform two segmental fusion surgeries at the same time would require general anesthesia, 3 hours of operation time, 10 cm of incision length, 500 ml of bleeding, more trauma, and partial loss of normal lumbar spine mobility. He recommended minimally invasive intervertebral foraminoscopic techniques to the patient, who took the initiative to contact the hospital to prepare for the surgery after learning more about the patient’s case, which was characterized by lumbar lateral saphenous stenosis based on disc herniation. The attending physician, Dr. Chuanli Zhou, had accumulated a lot of experience in the treatment of lumbar disc herniation by foraminoscopy, and also carried out surgical treatment of multi-segmental lumbar disc herniation with satisfactory results, but had less experience in minimally invasive treatment of lumbar spinal stenosis, especially since the biggest difficulty of this patient was the stenosis of two segments, could the compression of two segments be solved at the same time under local anesthesia? Can most of the patient’s problems be solved after surgery? Can the patient tolerate prolonged surgery in the prone position? After repeated preoperative examinations, reading the patient’s imaging data, determining the responsible segment, extrapolating various puncture routes, anticipating many possible difficulties and thinking of countermeasures, we finally decided to perform a single-incision multi-segment lumbar decompression for the patient. Pre-operative analgesia was provided to lower the patient’s pain threshold, and the G-arm was used intraoperatively to reduce the prone time and the amount of radiation, which lasted 2.5 hours, with less than 10 ml of bleeding and an incision of only 7 mm. Intraoperatively, the disc tissue was found to be protruding posteriorly, the lateral saphenous fossa was severely narrowed, and the L5S1 segment, which was originally thought to be less compressed, was more severely compressed than the imaging, and the surgical strategy for both segments was well chosen. Immediately after surgery, the patient felt both bilateral posterior thigh tension disappeared, and the pain and numbness in both lower extremities disappeared after going down on the second day.