The patient came to the clinic 06-September-2003 complaining of LBP with bilateral sciatica more the right and weak left foot. She was operated 13 months ago elsewhere without improvement. The patient is diabetic for 7 years in treatment.

On examination: the patient is in agonizing pain. limping with exaggerated scoliotic stance. SLRS was 80 degrees with pain right side. Weak dorsiflexion right foot 3/5.

The patient was sent for investigations and MRI lumbar spine performed 07-September-2003 showing right extraforaminal extrusion both L3-4 and L4-5.

Decompressive laminectomy L4-5 and L3-4. There was massive scar in this area and scarolysis with foraminotomy both L5 and L4 were achieved both sides. The extruded disc L4-5 and L3-4 were removed from the right side and right sided intradiscal cleaning L4-5 and L3-4 was achieved. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Routine closure of the wound. Smooth postoperative recovery. The power of the right foot improved.

The patient came to the clinic 25-September-2003 with clean wound and no motor, nor sensory deficit. There is weak quadriceps muscles both legs 4/5.

The patient then came 03-December-2003 and 14-August-2004 complaining of polyarthralgia with neck pain and weak grip and extension right hand and right triceps muscle. She was sent for MRI cervical spine done 09-September-2004 showing multiple bulge disci. so the lumbar spine.

The last time she came 17-January-2010 telling that the last week got neck pain and frozen right shoulder. She was treated conservatively.

The patient still having an estimated postoperative recurrence around 14% because the disc spaces are still not completely shallow.