The patient came to the clinic 20-June-2009 complaining of LBP and left sciatica for one week. The patient is a known hypertensive and diabetic.

On examination: the patient was limping with exaggerated scoliotic stance and weak dorsiflexion both feet 4/5 more the left . SLRS was 80 degrees with pain in the left.

MRI lumbar spine performed 20-June-2009 showing extruded disc L4-5 with left foraminal occlusion and secondary severe segmental stenosis at this level.

Laminectomy of L4 and upper edge of L5 was performed. Bilateral foraminotomy of L5 roots was achieved. The extruded disc was removed lateral to the axilla and meticulous cleaning of L4-5 disc space was achieved from the left lateral to the axilla. There was a remnant of epidural fat in the right side which was shifted to the left L5 root to minimize the scar formation over it. Routine closure of the wound

Smooth postoperative recovery with improvement of the power of both feet.

The patient still having considerable height of the disc space, which make the expectation of recurrence around 7%.

So as to avoid dramatic clinical deterioration in case of possible recurrence the foraminotomy was extended more down to have ample to the root in case of recurrence and the stenotic elements were eliminated all over.