The patient came to the clinic 18-February-2013 complaining of LBP with left sciatica for 5 months with numbness of the left S1 territory.

MRI lumbar spine done 11-November-2012 showing huge extruded disc L5-S1, wide based with left downward migration.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 50 degrees with pain in the left side. There is weak dorsi and planterflexion left foot 4/5 with hypalgesia left L5 and S1 territories.

The patient was sent another time for investigations, which confirmed the presence of the huge extruded disc L5-S1 with left downward migration and the dynamic studies ruled out the presence of spondylolisthesis.

Using C-arm the L5-S1 level was identified. A 20 mm length incision was done. Left S1 foraminotomy was done and the huge old hard and recent soft in consistency extrusion was removed lateral to the axilla. Left intradiscal cleaning of L5-S1 was achieved. The root became lax and free.

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

The patient had huge extrusion of L5-S1 and the disc space is still not shallow, for what the expected postoperative recurrence is around 7%.

The extruded calcified annulus fibrosis was removed to eliminate all the compressive elements.