The patient came to the clinic 11-December-2003 complaining of LBP with bilateral sciatica for 15 years. The last 5 months exacerbation of right sciatica down to the L5 territory and inability to walk more than 50 meters, due to intermittent claudication. The patient is not diabetic, nor hypertensive, but having bronchial asthma in Ventolin. MRI lumbar spine performed 11-December-2003 showing lumbar canal stenosis L4-5.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 30 degrees left side with pain and 60 degrees right side with pain. There is weak dorsiflexion both feet -4/5.

The patient was sent for investigations and MRI lumbar spine performed 24-February-2004 showed stenosis of L4-5 with left extruded disc L4-5 with foraminal occlusion.

Decompressive laminectomy L4-5, bilateral L5 root foraminotomy with removal of the huge extrusion lateral to the axilla. After that, the root became lax and left 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 free fat was harvested from the subcutaneous layer and covered the exposed parts of the root, to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The power of both feet normalized.

The patient came to the clinic 16-March-2004 with clean wound and SLRS 30 degrees left side with pain and normal power and sensation of both feet.

The patient then came 22-June-2004 complaining of left hip pain with left sciatica. MRI lumbar spine and done 09-June-2004 showing no recurrence with mild spondylolisthesis L4-5.

The patient then came 24-December-2004 complaining of neck pain with left upper limb with weak grip. extension left hand and left triceps 3/5. She was sent for investigations, but she disappeared.

The estimated postoperative recurrence is still ranking around 7%, because the disc space is still relatively shallow.