The patient came to the clinic 15-January-2008 complaining of right hip pain for 25 days with right sciatica down to right L5 territory.

MRI lumbar spine performed 09-January-2008 demonstrating extruded disc L5-S1 with right huge far-lateral disc protrusion and left upward migration. The patient cannot walk more than 20 meters.

On examination:  SLRS was 80 degrees in the right and 90 degrees in the left. with weak dorsiflexion both feet 4/5, and hypalgesia right L5 territory.

The patient was advised to keep in conservative treatment in the hope, that the far-lateral extrusion can get a shift or resorption.

The patient could not wait and the pain became agonizing, that another MRI was performed 19-January-2008 confirming, that the lesion still the same.

Bilateral flavotomy of L5-S1 was done. It was so wide, that, it was necessary to use the image-intensifier, the level was identified and the right far-lateral extrusion was seen and a huge amount of extrusion was removed. The left upward migrating material was attacked from the left side and removed.

Bilateral meticulous cleaning of the disc space was achieved.

Routine closure of the wound.

Smooth postoperative recovery and the power of both feet dorsiflexion improved.

The patient had very wide space between L5 and S1. Usually we do not use the image-intensifier to localize the level at L5-S1, but in this case to avoid further bony removal and waist of time image intensifier was used to define the level.

Meticulous bilateral cleaning with relatively small height of the disc space  are lowering the estimated recurrence rate in this case.