The patient  came to the clinic 05-November-2006 complaining of LBP with left sciatica for 8 months with exacerbation the last 10 days. SLRS was 40 degrees with pain in the left with weak dorsi and planterflexion left foot 4/5 with hypalgesia left L5 and S1 territories. MRI done 07-November-2006 showing extruded disc L5-S1 more to the left. It was decided to try conservative treatment and surgery was added as an option in case of not improving.

The patient then got another attack of LBP with left sciatica the last 40 days for what MRI of the lumbar spine was repeated 18-April-2012 in UAE and showing huge extruded disc L5-S1 with left foraminal occlusion.

On examination, the patient is limping with exaggerated scoliotic stance with SLRS 30 degrees with pain in left side. There is weak dorsi and planterflexion both feet  -4/5. Positive cough sign.

Left S1 foraminotomy with reflection of the ligamentum flavum to the right. The old hard extrusion was removed by several means and left sided cleaning of L5-S1 disc space was achieved. The root was lacking the epidural fat, for what Guardix-so;. 1.5 ml was applied to the area to minimize the postoperative adhesions. The flavum was returned back in place.

Routine closure of the wound. Smooth postoperative recovery. The power of the left foot became normal.

The patient has an extruded disc of L5-S1 which is enlarging over the time. Surgical intervention became the only solution for her problem.

The estimated postoperative recurrence in this case is below 7% because the disc space is relatively shallow.