The patient came to the clinic 04-November-2013 complaining of right sciatica for 45 days down to the lateral aspect of the right foreleg. MRI lumbar spine done 28-October-2013 a bad quality, but showing extruded disc L1-2 with first degree spondylolisthesis L5-S1.

On examination is limping, in agonizing pain with exaggerated scoliotic stance. SLRS was 75 degrees right side with pain. There is weak dorsiflexion right foot 4/5.

The patient was sent for new MRI with LSS X-ray with dynamic studies, which showed severe old stenosis at L1-2 level with huge extruded disc L3-4 with total stenosis and mild spondylolisthesis of L5-S1 of no clinical significance. The old extruded disc of L1-2 is calcified.

Using C-arm, the L1-2 level was identified and lower 2/3 of L1 and upper 2/3 of L2 laminae were drilled out with foraminotomy of right L2 root. The epidural fat was missing due to severe compression. The hard calcified disc was explored from the right side. It was decided not to violate it. Through another separate incision, the L3-4 was approached and l1minectomy of the upper third of L3 and lower third of L4 was done with foraminotomy of the right L4 root. The extruded disc of L3-4 was removed and right sided cleaning of L3-4 disc space was achieved. Routine closure of the wounds.

Smooth postoperative recovery. The power of the right foot became normal.

The patient has double problems and they must be resolved even through separate incisions to minimize dissection trauma.

The estimated postoperative recurrence of L3-4 is still around 7%, because the disc space is still not completely shallow.