The patient came to the clinic 14-June-2012 with known history of MS for 8 years under treatment with Imuran and Symmetrel complaining of LBP for three months with right sciatica.

On examination, the patient is limping with exaggerated scoliotic stance. SLRS was 75 degrees right with pain. There is hypalgesia right leg above the knee with weak dorsi and planterflexion right foot 3/5.

MRI brain done 14-June-2012 showing the old MS scattered foci and a small en plaque meningioma over the left frontal pole of no significant value and lumbar spine showed  extruded disc L4-5 with right downward migration.

Laminectomy L4 and lower half of L3 and upper half of L5. Foraminotomy right L4 and L5 roots. The extruded disc of L3-4 was removed from the right side and right sided cleaning L3-4 was achieved. The L4-5 extrusion was bony hard and adherent with the root. It was drilled out. The disc space was empty and very shallow. Further foraminotomy for both roots to ensure that no compression at the exit foramina. There was no epidural fat at the working area, for what Guardix-sol was applied to minimize postoperative adhesions.

Routine closure of the wound. Smooth postoperative recovery and the power of the right foot became normal.

The patient has estimated postoperative recurrence for L4-5 around 0%, but for L3-4 still around 7% because the disc space of L3-4 is still not shallow.