The patient came to the clinic 06-September-2008 complaining of left sciatica for 5 months with exacerbation the last month. The patient has polycystic kidneys and arterial hypertension for 10 years.

On examination: the patient is limping with exaggerated scoliotic stance  with SLRS 30 degrees in the left with pain and almost drop left foot and weak planterflexion left foot 4/5.

MRI lumbar spine was performed 16-August-2008 showing extruded disc L5-S1 with left downward migration.

Left partial flavotomy of L5-S1 was done and foraminotomy of left S1 root. The extruded disc was removed from under the axilla, after what the laterally compressed S1 root became lax. The lateral dural wall of the root was adherent to the ligamentous structures confirming the long-standing presence of the problem. The disc space was cleaned from under the axilla and lateral to the axilla. Meticulous cleaning was achieved from the left side.

Smooth recovery with prompt improvement of the power of the left foot.

The patient has severe compression of the root by the downward migrating big piece. In this situation only surgery can resolve the problem.

The degree of improvement will depend upon the recovery of the root, which depend upon the preoperative damage of the root and the time delay since the occurrence of the extrusion.

The expected recurrence rate in this case is around the average, because the disc space height still considerable and the defect in the annulus fibrosis is not small.