The patient  came to the clinic 29-January-2011 complaining of LBP for 20 years with bilateral sciatica and numbness. Exacerbation of left sciatica for one day with difficult walking. SLRS was 40 degrees in the left with pain with weak dorsi and planterflexion left foot 4/5 with hypalgesia left S1 root.

MRI lumbar spine done 30-January-2011 showing small extruded disc L5-S1 with downward migration left side.

The patient then came 24-April-2012 complaining of severe sciatica with scoliotic stance with inability to stand up. 

On examination, the patient is unable to stand up with exaggerated scoliotic stance with SLRS 30 degrees with pain in left side. There is weak dorsi and planterflexion both feet  -4/5.

The patient was sent for MRI lumbar spine and performed 25-April-2012 showing very huge extruded disc L5-S1 with far downward migration left side.

Left S1 foraminotomy with exposure of the extrusion subaxillary and removal from that point. The root is severely adherent to the extrusion, for what it was needed to remove it stepwise to prevent damage to the compressed root. After the root was completely decompressed, it was possible to shift it medially and further cleaning of L5-S1 disc space was done lateral to the axilla. 1.5 ml Guardix-sol was applied to minimize postoperative fibrosis.

Routine closure of the wound. Smooth postoperative recovery. The power of  the left foot became normal.

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