The patient came to the clinic 03-April-2013 complaining of LBP with right sciatica for 10 years. The last month the LBP with bilateral sciatica more the right with numbness both feet. MRI lumbar spine done 11-March-2013 showing bulge L4-5 and extruded disc L5-S1 with right foraminal occlusion.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 10 degrees right side and 40 degrees in the left with pain. Weak dorsiflexion left foot -4/5 and right foot 3/5 with weak planterflexion right foot 4/5. There is hypalgesia of the right hand.

The patient was sent for more investigations. MRI of the brain and cervical spine done 04-April-2013 were uneventful. MRI of the lumbar spine showed huge extrusion L5-S1 with right foraminal and downward migration.

Using C-arm the level of L5-S1 identified. Right S1 foraminotomy with preservation and reflection of ligamentum flavum to the left. The extruded part of the disc to the foramen was removed in 2-3 pieces. The L5 lamina was flail, but no data to support spondylolisthesis or isthmolysis. Right sided intradiscal cleaning of L5-S1 disc space.

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

The patient had flail L5 lamina. In retrospective interrogation with the family after surgery, the patient 10 years ago underwent local illegal therapy by hitting the back with wood stick.

The flail lamina of L5 is still unclear how it plays in the clinical setup. Time will tell.

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