The patient came to the clinic 29-March-2004 complaining of LBP with right sciatica for 12 years with exacerbation of LBP with right sciatica for 20 days with positive cough sign. She is L-thyroxin 125 microgram daily for 4 years.

On examination, the patient in agonizing pain, limping with exaggerated scoliotic stance with almost drop right foot and hypalgesia right L5 territory. SLRS was 25 degrees right side with pain.

The patient was sent for investigations and MRI lumbar spine performed 06-April-2004 showing huge extrusion of L4-5 with right downward migration.

Foraminotomy right L5 roots was achieved. Right sided intradiscal cleaning L4-5 was performed with removal of the right far-lateral and downward migrating pieces. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. A free fat was harvested from the subcutaneous layer and covered the exposed parts of the dura and roots to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The power of both feet normalized.

The patient came to the clinic 05-May-2004 with clean wound with weak dorsiflexion 4/5 of the right foot.

The patient then came 26-July-2015 telling that the patient felt down 1 month ago after what got right hip pain. She was not limping with normal stance with weak dorsiflexion right foot 4/5. She was sent for investigations and MRI lumbar spine done the same day ruling out recurrence of the disc. She was treated conservatively.

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