The recurrence rate in this case still ranking around 7% because the disci spaces are not completely collapsed.

The operation was bloody and the old extrusion caused adherence of the ligamentum flavum with the dura, which was the cause of these dural tears. These 2 elements complicated the surgical steps.

The patient came to the clinic 25-March-2003 complaining of LBP for 10 years with left sciatica for 3 months with numbness of the entire left foot. MRI lumbar spine performed 12-March-2003 showing huge extruded disc L4-5 with left foraminal occlusion.

On examination: the patient in pain, limping with exaggerated scoliotic stance. SLRS was 30 degrees with pain left side. There is weak dorsi and planterflexion left foot, hypalgesia left L5 and S1 territories.

Left L4-5 hemiflavotomy with foraminotomy left L5 root. During dissection a dural tear took place antero-medial to the axilla, which was stitched using nylon 4 zero. The extruded disc of L4-5 was attacked from the left and left sided intradiscal cleaning done. Another inspection of the area showed another tear below the first, which was stitched by nylon also. 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 radicular pain decreased and the power of the left foot improved. He was sent to the ward.

The patient came to the clinic 07-April-2003 with clean wound, normal power and sensation left foot. SLRS was 75 degrees with less pain left side. There is numbness I and II toes left foot.

The patient then came 06-May-2003 10 days after suffering trauma to the back with LBP without sciatica. SLRS was 90 degrees both sides and no sensory or motor deficit. He was treated conservatively.