The patient came to the clinic 24-October-2012 complaining of LBP with bilateral sciatica more to the left after falling down 10 days ago. MRI lumbar spine done 20-October-2012 showing huge extruded disc L4-5 central more to the left with secondary canal stenosis. Pelvis CT-scan showing linear fracture right iliac bone.

On examination: the patient using 2 crutches to walk, limping with exaggerated scoliotic stance. SLRS was 0 degree in the left side with pain and there is weak dorsiflexion both feet 4/5.

The patient then came 24-December-2012 with left sciatica but SLRS was 80 degrees with still weak dorsiflexion both feet 4/5.

Complete laminectomy of L4 and partial of L5. Bilateral foraminotomy L5 roots. There is no epidural fat due to severe compression. Bilateral intradiscal cleaning L4-5 until the central extrusion was pushed to the disc space and removed from both sides. Most of the posterior part of annulus fibrosis was removed to decrease the postoperative recurrence.

Routine closure of the wound. The power of both feet became normal.

The patient had an estimated postoperative recurrence rate around 7%, because the disc space height is still not shallow.

Most of the posterior part of annulus fibrosis was removed to decrease the postoperative recurrence from both sides. Time will tell if this manipulation can decrease the recurrence.