The patient came to the Shmaisani hospital 04-October-2012 complaining of LBP for 15 years with intermittent course and agonizing left sciatica for 2 weeks down to the left S1 territory with numbness of the III-V toes left foot with inability to walk the last week. The patient is a known diabetic for 5 years and with arterial hypertension for 2 years.

MRI of the lumbar spine done 29-September-2012 showing huge extruded disc L5-S1 with left up and downward migration.

On examination, the patient is unable to stand with agonizing pain. SLRS was 65 degrees with pain in the left. There is weak dorsi and planterflexion left foot -4/5. with hypalgesia left L5 and S1 territories. The left AJ is absent.

Left L5-S1 hemiflavotomy with foraminotomy left S1 root. The root was severely compressed posterior by the extrusion. The extrusion was removed in steps to avoid injury to the compressed root and it was removed in one big piece. Trying to avoid widening of the defect in the annulus fibrosis, intradiscal cleaning of L5-S1 was achieved. The running epidural veins were preserved. Inspection for remnants subaxillary was negative. The root hanging free, but lacking the epidural fat. We stopped using Guardix-sol because it seems that it cause some sort of chemical neuritis and the followed postoperative MRI showed massive fibrosis due to reaction with Guardix-sol.

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

The patient still has an estimated postoperative recurrence around 10%, because the disc space is still high.