The patient came to the clinic 31-May-2014 complaining of LBP for 1 year with left sciatica with difficult walking and numbness all toes left foot. MRI lumbar spine done 29-April-2014 showing extruded disc L4-5 with left downward migration with bulge other disci.

On examination; The patient is not limping with exaggerated scoliotic stance. SLRS was 40 degrees in the left with pain. There is weak dorsiflexion left foot 3/5. The patient sent for new investigations, which confirmed the presence of the mentioned extrusion and no elements of instability. ESR was 60 mm/h and CRP was 41 mg/L.  The patient was started in Zinnat 500 mg twice a day, a day before surgery.

Using image-intensifier, the L4-5 level was identified. Using MICRODISCXS system and VITOM with tower, Left sided L4-5 hemiflavotomy with hemilaminectomy upper forth of L5 was done. The extruded disc was severely adherent to the left L5 root. It was necessary to go up to the disc space of L4-5 lateral to the axilla and decompress it to make it feasible to move the downward migrating piece, which was removed in several pieces. Foraminotomy of the left L5 root. Left sided cleaning L4-5 disc space. The root hanging free and inspection for residual of the downward migrating piece was negative. Routine closure of the wound.

Smooth postoperative recovery. The power of left foot became normal.

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