The patient came to the clinic 01-May-2007 complaining of right sciatica for 4 months. He was limping with scoliotic stance. SLRS was 60 degrees in the right with pain with weak dorsiflexion right foot 4/5. MRI lumbar spine requested and done 02-May-2007 showing extruded disc L5-S1 with downward migration. The patient was advised to undergo surgery, but he disappeared.

The patient then came 03-July-2011 claiming that he got deterioration the last 45 days with more exaggerated scoliotic stance with SLRS 30 degrees in the right with pain and weak dorsi and planterflexion right foot 4/5.

MRI lumbar spine done 03-July-2011 showing the same extrusion as before.

Right S1 foraminotomy with partial flavotomy. The root is adherent to the extrusion. The root was separated from the the extrusion and the extrusion was removed lateral to the axilla. Right sided cleaning of L5-S1 disc space.

Routine closure of the wound.  Smooth postoperative recovery with normalization of the power of the right  foot with disappearance of right sciatica.

The estimated postoperative recurrence rate is around 7% because the disc space of L5-S1 still not shallow.

The patient escaped the first surgery, claiming that physiotherapy gave him relieve. In this case the patient came after failed physiotherapy.

The patient mostly had the disc extrusion shrunk in size, for what he was improved, but further extrusion took place in the last 2 months.

The adherence of root to the extrusion confirm that the extrusion remained all the time and further disc extrusion took place above the old one.