The patient came to the clinic 27-September-2003 complaining of LBP with right sciatica for 2 months with exacerbation last 8 days. MRI done 24-September-2003 showing huge extruded disc L4-5 more to the right with downward migration. The patient is diabetic for 23 years and hypertensive for 15 years in treatment.

On examination: the patient is in agonizing pain, limping came with walker with exaggerated scoliotic stance. SLRS was 30 degrees both sides with pain. There is almost drop right with weak planterflexion same foot 3/5.

Decompressive right  L4-5 hemiflavotomy with foraminotomy L5 root right side .The very huge piece was removed from under the right L5 axilla. Right sided L4-5 discectomy lateral to the axilla and right sided intradiscal cleaning of L4-5 space was achieved. The epidural fat was transferred around the L5 root to minimize postoperative adhesions. 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 still weak 4/5.

The patient came to the clinic 15-October-2003 with clean wound and the power of the right foot still weak 4/5. SLRS was 60 degrees. There is numbness right L4 territory.

the patient then came 04-March-2004 complaining of LBP for 2 days with right foot. SLRS was 80 degrees with hypalgesia right L5 territory and weak dorsiflexion right foot 4/5. He was treated conservatively.

There is still an estimated postoperative recurrence around 7% because the disc space is not completely shallow.