The patient came to the clinic 01-May-2013 complaining of LBP for 6 years with left sciatica for 45 days down to all toes left foot. She cannot walk more than 20 meters due to agonizing pain. The patient is a known diabetic for 4 years and has arterial hypertension for 1 year.

MRI lumbar spine done 29-April-2013, bad quality, showing lumbar canal stenosis L4-5with wide based extrusion more to the left and suspected right upward migrating disc of L3-4.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 60 degrees left side with pain. There is drop left foot 0/5 and planterflexion -4/5. There is analgesia of the left L5 root territory. There is severe OA both knees with pain both knees and inability to flex the knees less than 90 degrees.

The patient was sent for investigations and MRI lumbar spine performed 02-May-2013 showing extruded disc L1-2 and L4-5 with left downward migration resulting in complete segmental stenosis L4-5. Dynamic studies ruled out instability. Bone density scan was normal.

Decompressive laminectomy L4 and upper half of L5. Foraminotomy left L5 root. The dura was severely compressed and lacking the epidural fat. Inspection of the annulus fibrosis from the left revealed an extruded disc which needs removal and left sided cleaning of L4-5 disc space.

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

The patient has  2 extrusions, one of them needs surgery. The extruded disc of L4-5, which causing drop left foot is the major indication for surgery.

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