The patient came to the clinic 27-July-2003 complaining of LBP for 3 years with left sciatica after suffering fracture left foot. Exacerbation of the LBP with right sciatica last 2 months. MRI lumbar spine done 10-July-2003 showing extruded disc L4-5 with right downward migration with stenosis of the left S1 root.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 20 degrees right side with pain. There is hypalgesia right L5 and S1 territory with almost flail right foot.

Decompressive laminectomy L5 and lower half of L4 and upper half of L4 with foraminotomy of L5 and S1 roots both sides. Right sided discectomy L4-5 lateral to the axilla. The downward migrating huge piece was removed subaxillary. Inspection the left side. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Epidural transfer and free fat obtained from under the skin was used to cover the dura to minimize the postoperative adhesions. Routine closure of the wound. Smooth postoperative recovery. The power of right foot improved. She was sent to the ward.

The patient then came 14-August-2003 with  clean wound, SLRS was 40 degrees with pain right side, weak dorsiflexion right foot 4/5 with numbness right S1 territory.

The patient then came 09-August-2005 complaining of LBP and frozen thumb right hand.  SLRS was 80 degrees right side with mild weakness right foot 4/5 with hypalgesia right L5 root with OA both knees. The patient was sent for investigations, but she disappeared.

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