The patient came to the clinic 12-March-2008 complaining of LBP for 26 years with bilateral sciatica. The left sciatica progressed the last 6 months with neck and both shoulders pain with numbness left hand. On examination at that time, there was neck pain when looking to left and up with weak grip and extension left hand 4/5. There was hypalgesia median distribution right hand. SLRS was 70 degrees with pain in the left with weak dorsiflexion left foot 4/5. MRI of the brain done 19-March-2008 showed scattered small lacunar infarctions both cerebral hemispheres. PCD C4-5, C5-6 with mild spinal cord compression. Bulge D12-L1, L1-2, L4-5 and L5-S1. The patient was advised to be treated conservatively.

The patient then came 10-February-2014 complaining of LBP with agonizing left sciatica for 2 weeks. MRI lumbar spine done 09-February-2914 bad quality, but showing extruded disc L5-S1 with left foraminal occlusion.

On examination; the patient is in agonizing pain, limping, with exaggerated scoliotic stance. There is left sided hemihypalgesia. The neck movements and power both upper limbs were normal. SLRS was 10 degrees with pain in the left. There is weak dorsi and planterflexion left foot 3/5.

MRI of the lumbar spine repeated the same day showing extruded disc L5-S1 with left downward migration. It was agreed with the patient to try conservative treatment and in case of not improving to consider surgery. The patient then came 03-March-2014 urging for surgery.

Using C-arm, the L5-S1 level identified. Far foraminotomy left S1 root. The extruded disc was severely compressing the root. The extruded disc was removed lateral to the axilla. The root was in bad shape due to old compression. Inspection of the root and subaxillar area. Routine closure of the wound.

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

The patient  still have an estimated postoperative recurrence rate below 7%, because the disc space still not completely shallow.