ABSTRACT Background data: Response shift is a new concept in the evaluation of patient satisfaction, application of such concept in the field of spinal surgery is important because of variation of outcome measures. Spine problems constitute a major health burden all over the world. Purpose: Is to evaluate patient satisfaction after undergoing lumbar spine surgery and comparing patients with pure lumbar spine pathology with those having painful lower limb pathology associated with the original spine lesions. Study design: A prospective comparative study. Patients and methods: One hundred twenty six patients having lumbar spine pathology with radicular compression causing sciatica were evaluated pre and post operatively using patient self assessment questionnaire, visual analogue score (VAS). The study was conducted at Zagazig university hospitals from May 2014 to June 2015. There was 67 patients with associated lower limb painful pathology and 59 patients without lower limb painful lesions Results: Fifty seven out of 59 patients became better (VAS below 40). 34 changed to 32 patients with VAS from 41 to 60, 19 changed to 20 ( VAS from 61 to 80) and 6 to zero ( VAS from 81 to 100) in pure lumbar pathology group, while in the second group associated with painful lower limb pathology 37 (VAS 41 to 60), 19 (VAS 61 to 80), 11(VAS 81 to 100) changed to 23, 12, and 8 respectively, 0 patients changed to 24 with VAS from 21-40. Conclusion: patients who have lower limb painful lesions in addition to the original lumbar spine pathology tends to be less satisfied with the result of surgery than those patients having pure lumbar pathology.