The patient came to the clinic 15-March-2011 complaining of agonizing right sciatica for 10 days with numbness and weak right foot. The patient is a known diabetic under treatment for 10 years.

MRI lumbar spine performed 14-March-2011 showing extruded disc L4-5 with right upward migration.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 90 degrees in both sides without pain. There is weak dorsiflexion right foot -4/5. The patient was seen by cardiologist and approved her condition for G.A.

Right L4-5 partial flavotomy with drilling of the lamina high to reach the upward extrusion. The extruded disc was removed in several big pieces. The epidural fat in this area was missing due to compression. The extruded disc was compressing the right L4 root at the upper corner. It was released. Inspection of the L4-5 annulus fibrosis could not find the defect, from where the extrusion took place. It was glistening and not causing any compression, for what it was decided not to violate it.

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

SLRS was 90 degrees in both sides, because the extruded disc was sequestrated and separated from the disc space, for what no friction had place when moving the leg up.

It was hard to tell if the extrusion is from L4-5 or L3-4, but the proximity of the extrusion to L4-5 disc space and nearly 7-8 mm away from L3-4 could with certainty conclude that, the extrusion was coming from L4-5 disc space.

Due to these speculations, and the good alignment of the annulus fibrosis, it was decided not to violate the L4-5 disc space.