The patient  came to the clinic 01-January-2011 complaining of LBP with left sciatica for 5 months. MRI lumbar spine done 15-Novemebr-2010 showing huge extruded disc L4-5 wide-based with left foraminal occlusion.

On examination, the patient was limping with exaggerated scoliotic stance. SLRS was 70 degrees in the right with shooting pain and 60 degrees in the left with more pain. There is weak dorsiflexion left foot -4/5 and right foot 4/5.

The patient was sent for investigations and MRI performed 02-January-2012 showing huge extruded disc L4-5 with left downward migration. The patient was advised to undergo surgery, but he escaped.

The patient then came 30-May-2012 claiming that he did not improve and his condition the last week became worse.

On examination, he is still limping with more exaggerated scoliotic stance. SLRS was 45 degrees both sides with more pain in the right. The patient was urging for surgery, but he was sent for new MRI lumbar spine, which confirmed the presence of the old data.

Bilateral L5 foraminotomy with L4-5 flavotomy. The extruded huge disc was removed lateral to the left axilla. Bilateral cleaning of the disc space of L4-5. There is no epidural fat at the lower field of the exposure, for what Guardix-sol 1.5 ml was applied.

Routine closure of the wound. Smooth postoperative recovery and the power of both feet became normal.

The patient still have an estimated postoperative recurrence around 7%, even with bilateral cleaning, because the disc space height still not shallow.