The patient came to the clinic 29-November-2008 complaining of LBP for 3 years with right sciatica and left sciatica for three months.

On examination: the patient  is limping with exaggerated scoliotic stance and cannot stand up, instead with bended spine. SLRS was 20 degrees right and 30 degrees left with pain. She had weak dorsiflexion right foot -4/5 and left foot 4/5. Hypalgesia right L5 territory.

The patient was treated for Ca breast 8 years ago.

MRI of the lumbar spine with MRMyelography was performed 12-December-2008 showing wide based extrusion of L4-5 with right downward migration.

Bilateral flavotomy of L4-5 was performed and foraminotomy of both L5 roots was achieved. The extruded disc was removed from both sides and meticulous intradiscal cleaning of L4-5 was done. The axillae were inspected for remaining pieces or fragments. There was no epidural fat at the site of surgery. Routine closure of the wound.

Smooth postoperative recovery and the power of both feet normalized.

The extruded disc was more in the right side and the patient was complaining more from the left sciatica, for what bilateral cleaning was performed. The left L5 root was more compressed and even adherent at the inner angle of the left axilla to the surrounding tissues. This explain why she was suffering from left sciatica.

The expected recurrence rate in this case is above the average, because the disc space height still nor shallow and so as to perform meticulous cleaning , it was necessary to removed the disc material from 2 points in either side.