The patient the wife of Libyan Ambassador, came to the clinic 09-September-2003 complaining of LBP with right sciatica for 25 days with radiation down to the right S1 root territory. CT-scan lumbar spine done 02-September-2003 showing bulge disc L4-5 and extruded disc L5-S1.

On examination: the patient is in agonizing pain, limping with exaggerated scoliotic stance. SLRS was 20 degrees right side with pain. There is weak dorsi and planterflexion right foot with hypalgesia right S1 root territory. There is also pain neck when rotating the head to all directions with grip, extension right hand and right triceps muscle.

The patient was sent for investigations and MRI cervical spine showed bulge disci C4-5 and C5-6 with stenosis C4-5 and right sided extruded disc L5-S1.

Decompressive laminectomy L4-5 with laminectomy L5 and foraminotomy L5 and S1 roots both sides .Right sided L5-S1 discectomy lateral to the axilla and right sided intradiscal cleaning of L5-S1 space was achieved. The epidural fat was transferred around the left S1 root to minimize postoperative adhesions. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Routine closure of the wound. Smooth postoperative recovery. The power of the left foot normalized.

The patient came to the clinic 06-December-2003 with clean wound and the power of the right foot became normal. SLRS was 75 degrees. There is numbness right S1 territory.

the patient then came 25-January-2005 complaining of LBP with left sciatica, neck pain with weal flexion and extension left hand and left triceps muscle. She was sent for investigations and no signs of recurrence and the cervical data the same as before. She was treated conservatively.

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