The patient came to the clinic 03-September-2012 complaining of LBP for 10 months  with left sciatica for three months with numbness all toes left foot. She is suffering also from signs of CTS more the left for three months.

MRI cervical spine done 01-September-2012 showing bulge C3-4 and C4-5. MRI lumbar spine showing extruded disc L4-5 with left foraminal occlusion.

On examination, the patient is limping dragging her left leg without scoliotic stance. SLRS was 70 degrees in both sides with tightness. There is profound weak dorsiflexion left foot -3/5 with almost drop left foot. There is hypalgesia left L5 territory. Phalen test was positive to the right hand and compression of the right median nerve caused triggering of the night numbness of the right hand. The patient was sent for new MRI of the lumbar spine and the pelvis.

MRI lumbar spine performed 05-September-2012 showing huge extruded disc L4-5 with left downward migration. MRI of the pelvis showed fibroid of the uterus and polycystic ovaries. EMG confirmed the presence of moderate compression of both median nerves at the wrist more advanced in the right.

Left L4-5 hemiflavotomy with foraminotomy left L5 root. The extruded disc was approached lateral to the axilla. It was removed in several pieces. Left sided cleaning L4-5 disc space. The left axilla was free of fat due to severe compression. It became lax after completion of surgery.

Right CT-release was done.

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

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