The patient came to the clinic 24-September-2013 complaining of LBP with left sciatica for more than one year. He was operated 4 months ago in Yemen for this extrusion, but he did not improve. MRI lumbar done 11-September-2013 of bad quality showing extruded disc L4-5.

On examination: the patient is limping with scoliotic stance. SLRS was 70 degrees with pain in the left. He has weak dorsiflexion left foot 4/5 and the left quadriceps also 4/5. Inspection of the performed wound seems to be high at L2-3-4 levels.

The patient was sent for new MRI of the dorsal and lumbar spine, which were done 25-September-2013 showing extruded disc L4-5 with left foraminal occlusion of moderate size. There is also syrinx cavity of the spinal cord at D12-L1 level. Dynamic studies were uneventful. It was explained to the patient, that he could undergo conservative treatment and to be followed for his syrinx, but he insisted for surgery for the extruded disc.

Using C-arm, the L4-5 level was identified. Left L5 root foraminotomy with partial flavotomy was done. The extruded disc was removed lateral to the axilla. Left sided intradiscal cleaning L4-5 disc space.

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

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