The patient came to the clinic 09-October-2012 complaining of LBP and right sciatica for 4 months, down to the heel with positive cough sign. MRI of lumbar spine of bad quality done 16-August-2012 showing extruded disc L4-5 and L5-S1. The patient was in agonizing pain, limping, exaggerated scoliotic stance with SLRS 10 degrees in the right and 45 degrees with pain in the left. There was weak dorsiflexion and planterflexion right foot 3/5. MRI lumbar spine repeated 18-October-2012 confirming the presence of huge extrusion L4-5 with right downward migration and bulge L5-S1 and she was advised to undergo surgery, but she escaped.

The patient then came 29-September-2013 claiming that she has exacerbation of here LBP with right sciatica the last week. She was in agonizing pain. She is urging for surgery.

On examination: the patient is limping with scoliotic stance. SLRS was 10 degrees with pain in the right and 20 degrees with pain in the left. She has weak dorsiflexion both feet -4/5 and left foot planterflexion 4/5. She has hypalgesia right L5 territory. She performed MRI lumbar spine 17-February-2013 showing extruded disc L4-5 central more to the right. The patient was sent for new investigations.

MRI lumbar spine done 30-September-2013 showing huge extruded central disc L4-5 more to the right with bulge L5-S1.

Using C-arm, the level of L4-5 was identified. Foraminotomy both L5 roots with flavotomy both sides. Bilateral removal of the extrusion and cleaning f L4-5 disc space. There was no epidural fat due to severe compression.

Smooth postoperative recovery. The power of both feet became normal.

The patient still have an estimated postoperative recurrence around 5%, because the disc space height is still not shallow even bilateral cleaning performed.