The patient came to the clinic 16-October-2003 complaining of LBP for 3 years with left sciatica for for 6 months with intermittent claudication and cannot walk more than 20 meters. The patient is hypertensive for 2 years in treatment. Operated three time for thyroid 1985, in L-thyroxin 50 microgram daily. MRI bad quality done 26-September-2003 showing extruded disc L4-5 more to left with segmental stenosis.

On examination: the patient is in agonizing pain, limping with exaggerated scoliotic stance. SLRS was 90 degrees both sides without pain. There is weak dorsi and planterflexion left foot 3/5 with hypalgesia left S1 territory. The same noted in the right foot, but to lesser extent. There is still palpable hard mass in the thyroid region.

The patient was sent for new MRI which was done 19-October-2003 showing stenosis L4-5 with bulge L4-5.

Decompressive laminectomy L4-5. Foraminotomy both L5 roots was achieved. The extruded disc material of L4-5 was removed from the left side of the axilla with left sided intradiscal cleaning L4-5 was achieved. A free fat tissue piece obtained from the subcutaneous layer obtained and transferred to the root area to minimize postoperative scarring. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Routine closure of the wound. Smooth postoperative recovery. The power of the feet normalized.

The patient came to the clinic 09-November-2003 with clean wound and no motor, nor sensory deficit.

The patient then came 24-December-2004 complaining of LBP with swollen left knee for 3 days. She was treated conservatively for her knee problem.

There is still an estimated postoperative recurrence around 7% because the disc space not completely shallow.