The patient came to the clinic 24-February-2014 complaining of LBP for 2 months with left sciatica, which increased the last 45 days. MRI lumbar spine done 22-February-2014 showing severe lumbar canal stenosis L3-4 and L4-5 with suspected lesion in the left L4-5 extraforaminal territory. The patient is diabetic for the last 5 months.

On examination; the patient is in agonizing pain, limping, with exaggerated scoliotic stance. SLRS was 80 degrees both sides. There is weak dorsiflexion left foot 4/5 and hypalgesia left L5 territory.

MRI of the lumbar spine repeated 25-February-2014 showing extruded disc L3-4 and L4-5 with severe segmental stenosis.

Using C-arm, the L4-5 level identified. Laminectomy L4 with lower third of L3 and upper third of L5 was done. During that, several pieces of suspected tissue fragments were collected for histologic studies. Left L4, L5 foraminotomies. Discectomy L4-5 and the material sent for CXS. Discectomy L3-4 and left sided intradiscal cleaning L3-4 and L4-5 was achieved. 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 above 30%, because the disc space of both levels still not shallow.

In case of infection, antibiotics will be planned for several months.