The patient came to the clinic 27-July complaining of LBP since 1991. The last 70 days got right sciatica , three weeks later got left sciatica with inability to walk more then 100 meters. Using crutches for 10 days. MRI lumbar spine performed 27-July-2004 showing huge extruded disc L4-5.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 50 degrees in the right  and 80 degrees in the left with pain. There is weak dorsiflexion both feet 3/5 with hypalgesia left L5 and S1 territories.

Foraminotomy both L5 roots with removal of the huge extrusion lateral to the axilla from the right side. After that, the root became lax and right sided intradiscal cleaning L4-5 disc space was done. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. A fat in pedicle was transferred from the subcutaneous layer and covered the exposed parts of the dura and roots to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The power of the feet became normal. He was sent to the ward.

The patient came to the clinic 14-August-2004 with clean wound and SLRS 80 degrees both sides without pain and neurologically free.

The patient then came several times concerning his neck problems, but he came 01-September-2010 with MRI cervical spine done the same day showing bulge C5-6 central, more to the right.

The patient came 23-December-2010 with MRI done yesterday showing the same cervical extrusion and no recurrence of L4-5 with normal brain MRI.

The patient then came 06-January-2020 with MRI done yesterday showing osteomyelitis at L4 and L5 with right paravertebral collection and he was treated conservatively.

The estimated postoperative recurrence is still ranking around 7%, because the disc space is still relatively not shallow.