The patient  came to the clinic 09-April-2012 complaining of LBP for 10 years with left sciatica down to the lateral malleolus with numbness of the left L5 territory for 10 days. The patient is a known hypertensive for 10 years.

MRI lumbar spine performed 06-January-2009 showing bulge L4-5 and L5-S1 disci.

On examination, the patient is limping with exaggerated scoliotic stance with SLRS 80 degrees with pain in the left side. There is weak dorsi and planterflexion left foot 3/5. The left KJ is absent and the right AJ also.

The patient was sent for new MRI lumbar spine and performed 09-April-2012 showing left huge upward migrating disc L4-5.

Left L5 foraminotomy with far superior exposure of the axilla and about 10 mm above it. The posterior longitudinal ligament was incised to expose the far upward migrating piece, which was removed in one piece. Left sided cleaning of L4-5 disc space. The operation was performed with image-intensifier to minimize the wound length and dissection.

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

The patient still have an estimated recurrence rate around 7% because the disc space height is still not shallow.

The SLRS was 80 degrees despite the presence of huge extrusion. This is a sign that the extrusion was completely separated from the disc space material. If the extrusion was in continuity, then the patient could have more agonizing pain with SLRS around 20-30 degrees.