The patient came to the clinic 29-November-2011 complaining of LBP for 1 month with left sciatica after one week with numbness big toe left foot.

MRI lumbar spine performed 27-November-2011 showed extruded disc L4-5 with left downward migration with foraminal occlusion with bulge of the L5-S1 more to the right.

On examination, he could walk without limping, nor scoliotic stance, but SLRS was 45 degrees in the left with pain with weak dorsiflexion left foot 2/5 and analgesia left L5 root and hypalgesia left S1 root territories.

Using C-arm the L4-5 level was identified and left L5 foraminotomy with partial flavotomy was done. The root was severely compressed and there was huge veins covering the area after exposure. They were coagulated to make it possible to proceed. The extruded fragment was hard and it was removed by piece-meal fashion. The disc space of L4-5 was cleaned from the left side and osteophytectomy was achieved by drilling. The root became relax and free of any compression.

Smooth postoperative recovery with improvement of the power of  the left foot.

The patient had up and downward migrating disc  compression of the root with hard disc, causing agonizing sciatica. If the piece was soft, no need for surgery, but the piece is hard in consistency and it will not shrink with time.

The estimated postoperative recurrence is still around 7%, because the disc space is not shallow and the calcified annulus fibrosis which was part of the extrusion was removed.