A 61-year-old patient with pre-existing but asymptomatic spinal stenosis was placed in the lateral position on the operating table for hip surgery. The lumbar spine was in a position of extension and lateral bend. This position, combined with severe spinal stenosis (proven later at surgery), caused enough compression on the neural elements to produce permanent paraplegia. Similar cases have been reported but remain an infrequent cause of postoperative paraplegia.