The patient came to the clinic 04-September-2013 complaining of left hip pain for 3 months when walking more than 300 meters. Exacerbation of LBP with right sciatica and numbness of the right foot with drop foot for 1 month. Using crutches for 3 days.

MRI of the lumbar spine performed 20-August-2013  showing bulge L5-S1 with extruded disc L4-5 with right downward migration.

On examination: the patient cannot walk or stand with agonizing sciatica. He is using drop foot brace right foot for 4 days. The patient is limping with exaggerated scoliotic stance. There is drop right foot with hypalgesia right L5 root territory. SLRS was 60 degrees in the right with pain.

Considering the patient has lumbarization of the S1, the C-arm was used to identify the L4-5 level. Laminectomy of L4 and upper fifth of L5 was done. Foraminotomy of the right L5 root. The root was severely compressed by the extrusion and surrounding bony and soft tissues elements. The extruded downward migrating disc fragments were removed lateral to the axilla. Right sided intradiscal cleaning of L4-5 disc space.

Smooth postoperative recovery. The power of the right foot still the same.

The patient still have an estimated postoperative recurrence around 7% because the disc space height still not shallow.

When complete drop foot take place for several days before surgery, recovery will be partial and extend for several months.