The patient came to the clinic 17-June-2013 complaining of LBP with left sciatica for 4 months down to all toes left foot with numbness. She is a known diabetic with glucophage 850 mg once or twice for 2 years.

MRI of the lumbar spine performed 21-April-2013  showing extruded disc L4-5 with left foraminal occlusion and bulge L5-S1.

On examination: the patient is limping with exaggerated scoliotic stance. There is weak dorsiflexion left foot  3/5.  SLRS was 65 degrees in the left with pain. The patient was advised to undergo surgery, but she escaped. The patient then the last three days got an agonizing sciatica, that she was urging for surgery.

Using C-arm, the level of L4-5 identified. L4-5 flavotomy with right L5 foraminotomy was done. The epidural fat and the ligamentous structures were swollen as having inflammatory process. The extruded disc was friable and involved in inflammatory process, removed lateral to the axilla of the right L5 root. Right sided cleaning L4-5 disc space. The disc material was sent for CXS.

Smooth postoperative recovery. The power of the left foot became normal.

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