The patient came to the clinic 12-December-2013 directly from Sukhumi, Abkhazia with clinical history of agonizing LBP with left sciatica for 5 weeks with numbness of the toes of the left foot. He felt down 3 months ago with strain of the right hip, which resolved completely after one month.

On examination is limping, in agonizing pain with exaggerated scoliotic stance. SLRS was 70 degrees with pain shooting to the left leg and 5 degrees in the left side with more pain. There is almost drop left foot -3/5 with hypalgesia left L5 territory.

The patient sent for MRI lumbar spine and the pelvis with dynamic studies. MRI lumbar spine done 1 hour after clinical examination showed very huge extruded disc L4-5 with left downward migration. The patient was prepared for surgery 30 min after admission.

Using C-arm, the L4-5 level was identified. After dissecting the bone another check C-arm showed that the level was L3-4, despite that the wound was 30 mm length. The dissection was corrected inferior and  the lower 1/3 of L4 and upper 2/3 of L5 laminae were drilled out with foraminotomy of left L5 root. The root was shifted lateral for what subaxillary removal of the extrusion was undertaken. The disc space of L4-5 was cleaned lateral to the axilla. Routine closure of the wounds.

Smooth postoperative recovery. The power of the left foot became normal and the agonizing left sciatica disappeared.

The estimated postoperative recurrence of L4-5 is still around 7%, because the disc space is still not completely shallow.