The patient came to the clinic 17-February-2014 complaining of LBP for 20 months and right sciatica for 6 months with progression of pain and numbness all toes right foot the last 3 months .

On examination; the patient now is not limping with scoliotic stance. SLRS was 20 degrees with pain in the right and 70 degrees in the left with pain shooting to the right leg. The right AJ was absent. There is weak dorsi and planterflexion right foot 3/5. Hypalgesia right S1 root territory.

MRI of the lumbar spine done the same day showing huge extruded disc L5-S1 with right foraminal occlusion and downward migration.

Using C-arm, the L5-S1 level was identified. A 3 cm incision done according to the pointer. The patient is fat. Skeletonization of the area. Another check with C-arm showed the level of L4-5. Dissection carried out inferior. Right hemilaminectomy with foraminotomy right S1 root. The extruded disc was removed in several pieces lateral to the axilla. Right sided cleaning of L5-S1 disc space. There was a tiny CSF leak from the very transparent dural wall of the S1 root. It was coagulated and Valsalva maneuver was negative. A piece of muscle was transferred to the suspected area with routine closure of the wound.

Smooth postoperative recovery. The power of the right foot became normal. The agonizing radicular pain disappeared.

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