The patient came to the clinic 23-March-2013 complaining of LBP for 3 years with left sciatica for 1 month with exacerbation last week. The pain shooting down to all toes left foot more to the big toe.

MRI lumbar spine done 20-March-2013 bad quality showing small extruded disc L4-5 left side.

On examination: The patient is in agonizing pain, unable to walk or stand to evaluate for limping or scoliotic stance. SLRS was 40 degrees in the right with pain and 3 degrees in the left with more pain shooting to the right. There is weak dorsiflexion left foot 4/5 with hypalgesia left L5 and S1 roots.

The patient was sent for further investigations, which confirmed the presence of huge extrusion L4-5 with left foraminal occlusion with left downward migration with normal pelvic anatomy except for polycystic both ovaries.

Using C-arm, the level of L4-5 was identified, because the patient was fatty. Left partial L4-5 flavotomy and foraminotomy left L5 root was done. The extruded extrusion was removed lateral to the axilla in one piece. Left sided intradiscal cleaning L4-5 disc space.

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

There is still an estimated postoperative recurrence around 7%, because the disc space is still not shallow.