The patient was operated by me 08-December-2003 for extruded disc C3-4, C4-5 C5-6 and fusion was done at that time and 13-December-2005 for lumbar canal stenosis L3-4 and L4-5 then was operated for extruded disc L2-3 11-November-2010. She has old wedge fracture of D12 and mild spondylolisthesis L3-4 and L4-5. The patient is a known diabetic with IHD and was seen several time by cardiologist. She has also gout in Zyloric 100 mg once daily.

The patient then came 23-December-2012 complaining of LBP with bilateral sciatica more the right with numbness both legs below the knee. Using crutches and walking bended. There is micturition problems.

On examination: the patient in agonizing pain. She is limping with exaggerated scoliotic stance. SLRS 90 degrees both sides with pain. There is weak dorsiflexion right foot 4/5 and left foot -4/5.

The patient sent for new investigations : CXR -cardiomegaly. LSS X-ray showed the old fracture of D12 and mild spondylolisthesis L4-5 and L2-3. MRI lumbar spine done 27-December-2012 showed huge extruded disc L3-4 with upward migration.

Using C-arm the L3-4 was identified and the scar was dissected off the right L3-4 lateral mass with the aid of the smallest size drill. Right sided cleaning of L3-4 with removal of the upward migrating huge disc in several pieces, trying during that to avoid tearing of the dura, which was seen clearly in some places and involved in scars in other area. The root of right L3 was seen and decompressed.

Routine closure of the wound. Smooth postoperative recovery. The power of both feet became better.

The patient has several problems including spondylolisthesis of several levels. Considering her age and the big extrusion of L3-4 with complete occlusion of the canal at this level, surgical removal of the extrusion and right sided cleaning was decided and the other problems intentionally were ignored.