The patient came 20-July-2010 complaining of LBP with bilateral sciatica for 1 year. The last month at that time, got neck pain and pain right upper limb with numbness of the index finger right hand. The patient was not limping with weak grip and extension of the right hand and weak triceps muscle right side 4/5. There was hypalgesia index right hand. MRI cervical done 21-July-2010 showed small extrusion C5-6, C6-7 and the patient was treated conservatively.

The patient then came 14-August-2013 telling that the LBP exacerbate the last 2 months with bilateral sciatica, more the right. The patient is limping walking bended anterior with exaggerated scoliotic stance.

On examination the patient has weak dorsiflexion both feet 3/5 and planterflexion both feet +3/5. SLRS was 25 degrees right and 35 degrees left with pain more in the right. AJ was absent both sides. The patient is diabetic.

MRI lumbar spine performed 17-August-2013 showing wide based extruded disc L4-5 with downward migration, more to the left resulting in segmental stenosis at this level.

Laminectomy L4 with foraminotomy both L5 roots. Bilateral cleaning L4-5 disc space.

Smooth postoperative recovery. The power of both feet became normal.

The estimated postoperative recurrence is around7-15% because the disc space height is still high. In case of recurrence fusion is advised.