The patient came to the clinic 21-February-2013 complaining of LBP for 5 years with exacerbation of bilateral sciatica more to the right the last 3 weeks with numbness of the right foot. The patient is a known diabetic under treatment.

MRI lumbar spine done 13-February-2013 showing huge extruded disc L4-5 with stenosis of L3-4 and L4-5.

On examination: The patient using crutches walking bended anterior with help of two persons, is limping with exaggerated scoliotic stance. SLRS was 15 degrees with pain in the right and 20 degrees in the left with less pain. There is weak dorsiflexion and planterflexion both feet 3/5 with hypalgesia both feet to the mid foreleg mostly diabetic in character. The right KJ and both AJs are absent.

Decompressive laminectomy L4 and upper half of L5 and lower 2/3 of L3. Foraminotomy both L5 roots. The extruded disc L4-5 was removed from the left side lateral to the axilla. Left sided intradiscal cleaning L4-5 disc space. The right side of the L4-5 annulus fibrosis was inspected. It was unremarkable.

Routine closure of the wound. Smooth postoperative recovery. The power of both feet became better.

The patient had huge extrusion of L4-5 without improvement. Surgical intervention is the only solution.

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

The accompanying stenosis must be resolved at the same surgical setting.