The patient came to the clinic 19-September-2004 complaining of severe LBP with left sciatica for 3 weeks. He is hypertensive for 7 months in treatment.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 45 degrees in the right  with pain and 5 degrees in the left with more pain. There is weak dorsi and planterflexion left foot 3/5 with hypalgesia left L5 and S1 territories.

The patient was sent for investigations and MRI lumbar spine performed the next day showing extruded disc L4-5 with left downward migration and bulge L5-S1.

Laminectomy L5. Foraminotomy left L5 and S1 roots with removal of the extrusion partially subaxillary under the axilla of L5 and mostly lateral to the axilla from the left side. After that, the root became lax and left sided intradiscal cleaning L4-5 disc space was done. Inspection of L5-S1 space, was uneventful. 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 left foot became normal. He was sent to the ward.

The patient came to the clinic 17-October-2004 with clean wound and SLRS 80 degrees left side without pain and normal power and sensation.

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