The patient came to the clinic 11-September-2012 complaining of agonizing LBP and right sciatica for 45 days without any improvement.

MRI lumbar spine done 30-July-2012 showing huge extruded disc L5-S1 with right downward migration.

On examination, the patient is limping with exaggerated scoliotic stance. SLRS was 30 degrees in the right with severe pain. The right AJ is absent. There is weak dorsi and planterflexion right foot -4/5. There is numbness of the little toe right foot.

Right S1 foraminotomy with reflection of the ligamentum flavum to the left. Part of the non-contained extrusion was removed lateral to the axilla and the major part was removed subaxillary. Right sided cleaning L5-S1 disc space. The reflected ligamentum flavum was returned back.

Routine closure of the wound. Smooth postoperative recovery and the power of the right foot became normal and the sciatica disappeared.

The patient was in agonizing pain because the extrusion was not contained (it penetrates the posterior longitudinal ligament) and the fragments was severely compressing the root.

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