The patient came to Emergency Shmaisani hospital 09-May-2004 complaining of LBP with left sciatica for 8 months with left sciatica for  2 months down to the left L5 territory. MRI lumbar spine done 08-May-2004 showing huge extruded disc L4-5 with left foraminal occlusion. Diabetic and hypertension for 20 years  under treatment. He was complaining of LBP with left sciatica in Kuwait for 5 years with intermittent course.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 30 degrees in the left with pain. There is weak dorsi and planterflexion left foot 3/5 with hypalgesia left L4 and S1 territories.

Foraminotomy left L5 root with removal of the extrusion lateral to the axilla. After that, the root became lax and left sided intradiscal cleaning L4-5 disc space was done. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. A free fat graft harvested from the subcutaneous layer transferred to the root area was preserved to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The power of the left foot became normal. He was sent to the ward.

The patient came to the clinic 19-May-2004 with clean wound and SLRS 80 degrees both sides without pain and no motor, nor sensory deficit.

The patient then came 25-February-2016 complaining of sudden onset inability to walk only with walker. Upon examination he had tetraparesis more profound in the lower limbs. MRI lumbar spine 23-January-2016 was uneventful. He was sent for thorough investigations, but he did not show up.

The estimated postoperative recurrence is still ranking around 7%, because the disc space is still relatively not shallow.

In the last visit, he had a serious problem in his cervical spine, but he did not come back.