This study investigated the differences in the clinical features of lateral recess syndrome attributable to the bony entrapment of the spinal nerve root under the superior articular facet, and lateral recess syndrome and associated lumbar disc herniation. Ninety patients with pure bony entrapment (47 men, 43 women) ranging in age from 19 to 83 years (mean age, 63 years) and 59 patients with lumbar disc herniation in the lateral recess (43 men, 16 women) 19 to 85 years of age (mean age, 49 years) were included in this study. All patients had L5 root radiculopathies and were treated surgically. Although the early symptoms of patients with lateral recess syndrome often were in the lower extremities, many of the patients with associated lumbar disc herniation had a transition initially experiencing low back pain and subsequently having lower extremity symptoms. Flexion and extension of the lumbar spine exacerbated symptoms, particularly in patients with lumbar disc herniation. The results of the current study show that the clinical presentation of lateral recess syndrome differs depending on the cause of the compression in the lateral recess.